Current guidelines for clinical practice for Intensive Care Paramedics is to treat dehydration and hypoglycaemia symptomatically, then follow the patient’s management plan if available.
If there is no management plan available, to treat crisis with 100mg of hydrocortisone which they do carry.
Adrenal Insufficiency (AI) is a condition in which the adrenal glands do not produce sufficient amounts of steroid hormones. These hormones play a critical role in maintaining osmoregulation. Acute AI is a life threatening event, predominantly occurring in Addison’s disease. Many of these patients have established management plans in place.
Precipitating factors of AI can include: Evidence of withdrawal from steroid medication, recent increase in physical or psychological stress or an acute illness.
Signs and symptoms of AI include, but are not limited to: altered GCS, dehydration resulting in hypovolaemia, hyperkalaemia, hypoglycaemia, nausea, vomiting, and abdominal pain.
2. Clinical Practice Guideline Details
- Basic care, including 12-Lead ECG and BGL
- Treat dehydration and hypoglycaemia symptomatically
- In the presence of an adrenal insufficiency diagnosis, treatment should follow existing management plan if available.
- In adults: Hydrocortisone 100 mg IV/IM/IO as a single dose
- In paediatrics: 4 mg/kg Hydrocortisone IV/IM/IO to a maximum total dose of 100 mg
- Provide transport and notify the receiving facility
Within Metropolitan Adelaide:
- Consider any direction in existing management plan
- Following the administration of hydrocortisone, stable patients should be transported to the geographically closest of the Lyell McEwin, Royal Adelaide or Queen Elizabeth Hospital or Flinders Medical Centre
- Unstable patients and those not requiring the administration of hydrocortisone should be transported to the geographically closest Emergency Department
SA Ambulance Service
Information Current as at 25 January 2018
Western Australian ambulances do not carry Solu-Cortef®. for injection for Adrenal Insufficiency patients and has no intention to at this stage.
They will however authorise their officers/paramedics to administer the patient’s own Solu-Cortef®. They encourage all AI patients to register with their local ambulance as an AI patient. It is important that all Western Australian adrenal insufficiency patients be prescribed the Solu-Cortef®. Act-o-Vial.
Clinical Services General Manager (Acting)
St John Ambulance Western Australia Ltd.
Information supplied – 13th December 2018
Update 14 March 2017
St John Ambulance will soon only be carrying dexamethasone for patients in adrenal crisis, however if the patient has their own Solu-Cortef®. Act-o-Vial., they will administer. St John’s has asked AADAI to inform members to register with their local ambulance as a patient living with Addison’s disease or Adrenal Insufficiency. Because NT ambulance does not carry Solu-Cortef®. Act-o-Vial, it is highly recommended that you obtain a prescription for this from your medical practitioner. Whilst they carry Dexamethasone for treatment in adrenal crisis, this is not as fast acting as Solu-Cortef®.
Intensive Care Paramedic, ACT Ambulance Service
No protocol for treatment of Adrenal Crisis.
If patients have a letter from their doctor and their own supply, they would administer the Solu-Cortef®.
Manager Clinical Practice Guidelines – Ambulance Victoria
Information supplied - 17th August 2018
Ambulance Tasmania currently carries Intravenous (IV) dexamethasone (a steroid) as well as IV fluids (normal saline), both commonly utilised in Adrenal Crisis.
At this stage Ambulance Tasmania does not have a treatment protocol for the management of acute adrenal crisis/Addison’s disease, however they do focus in it in training programs and is managed by paramedics on medical consult with retrieval consultants (doctors).
A/ Manager of State-wide Services
Medical Services, Ambulance Tasmania
Information supplied - 25th September 2018