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
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 Insufficient Patients be prescribed the Solu Cortef Act-o-Vial.
Update 14 March 2017
St John Ambulance will soon only be carrying dexamethasone for patient’s 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 our 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.
No protocol for treatment of Adrenal Crisis.
If patients had a letter from their doctor and their own supply they would administer the Solu Cortef.
Ambulance Tasmania currently carries Intravenous (IV) Dexamethasone (a steroid) as well as IV fluids (Normal Saline), both commonly utilised in Adrenal Crisis. Other complications of Adrenal Crisis such as hypoglycaemia and hyperkalaemia Ambulance Tasmania also has medications and specific protocols to manage.
At this stage Ambulance Tasmania does not have a treatment protocol for the management of acute adrenal crisis/Addison’s disease, however we do focus in our training programs and is managed by our paramedics on medical consult with our retrieval consultants (Doctors).
Information supplied - 25th September 2018
|A/ Manager of Statewide Services|