Lesson of the Week: Thyrotoxicosis in a patient with multiple trauma: value of “AMPLE” history taking

Case report

A 26 year old tall, slim, white man was admitted to the accident and emergency department because of trauma to the left side of his body sustained in a motorcycle accident. Initial assessment identified an intra-abdominal haemorrhage and fractured left femur. He had a Glasgow coma scale score of 15 and no evidence of any head or neck injury. A history from the patient showed that he had been fit and well and was not receiving any drug treatment. He was taken to the operating theatre for an urgent laparotomy, splenectomy, and orthopaedic fixation of the fractured femur. He had persistent tachycardia in the operating theatre (heart rate 120–150 beats/minute) but maintained a good blood pressure and urine output throughout. During the four hour procedure he was given 5500 ml of intravenous fluids and 9 units of blood.

He was subsequently admitted to the intensive care unit for assisted ventilation and cardiovascular stabilisation. His heart rate was 150 beats/minute, intra-arterial blood pressure 180/60 mm Hg, and central venous pressure 3 mm Hg. He …