Background Thyroid storm is a life-threatening manifestation of thyrotoxicosis and presents with fever, diaphoresis, tachycardia, hypertension, and widened pulse pressure. Case presentation We present a case of intraoperative thyroid storm in a 12-year-old female undergoing posterior spinal fusion. Despite adequate depth of anesthesia and analgesia, the patient was persistently tachycardic and hypertensive. The surgical procedure was uneventful. A thyroid panel drawn immediately after surgery showed undetectable thyroid stimulating hormone (TSH) and high free thyroxine (T4) consistent with thyroid storm. Conclusions Intraoperative thyroid storm in a pediatric patient is extremely rare with nonspecific clinical symptoms. Low to undetectable TSH and elevated free T4 is diagnostic.

We present the prototype of an adjunct to personal protective equipment (PPE) for intubation of patients with coronavirus disease 2019 (COVID-19). Acknowledging the risk of infection for the airway operator and personnel in the room when tracheal intubation is required for a COVID-19 patient, we designed a chamber that creates a microenvironment around the patient's head that limits the outward flow from a patient's airways to the airway operator with a filtered suction system in order to limit viral spread and lower contamination risk during intubation in non-negative-pressure rooms. The device was successfully tested in a simulation setting.