In a patient with myxedema coma, which action is essential in the initial management?

• A. Beta-blocker therapy
• B. Airway stabilization
• C. Insulin therapy
• D. Cooling

Answer: (B)

Airway stabilization is essential because myxedema coma often severely depresses respiration and mental status, with airway edema and reduced protective reflexes increasing the risk of airway obstruction. Protecting the airway and ensuring adequate ventilation must come first, typically with prompt airway management and assisted ventilation as needed, while supporting circulation and correcting hypothermia, hyponatremia, and glucose abnormalities. Once the airway is secure, you can proceed with definitive treatment such as intravenous thyroid hormone replacement and appropriate supportive care.

Beta-blocker therapy would worsen bradycardia and hypotension and is not part of initial management. Insulin therapy isn’t indicated unless there is a clear hyperglycemic state, and cooling is inappropriate because these patients are typically hypothermic and need warming rather than cooling.