Kevin was the paramedic on duty in the rapid response vehicle who answered an emergency call to a 63-year-old man at his home. He found the patient had collapsed and was not breathing. He had a poor airway and was blue/grey in colour; his wrist pulse was absent, although a neck pulse was felt. The patient’s wife was very distressed and found it difficult to tell them what was wrong. However, when asked about medication, she produced his hydrocortisone. With further questioning, she was able to tell Kevin about her husband’s long history of chronic lung disease, diabetes, removal of a kidney with a tumour and adrenal failure.
Treatment began with resuscitation by securing the patient’s airway. The ambulance crew took over breathing for the patient using a ‘bag and mask’ with 100% oxygen. They administered hydrocortisone and a saline drip to improve his blood pressure. The local ambulance protocol recommends 100mg initially and a further 100mg 20-30 minutes later, if the patient does not begin to improve. In view of the patient’s condition, the crew gave the full 200mg immediately. During the journey to hospital, the patient responded quickly to treatment, regained consciousness and was able to breathe unassisted. From commencement of resuscitation to sitting up in the ambulance took between 20 and 30 minutes. The patient made a complete recovery and was discharged from hospital two days later.
This was the first time the crew had knowingly treated adrenal crisis since a training session some weeks earlier. Sue Cox, the endocrine nurse who has led paramedic education in this area, met them in the casualty department and reassured the paramedics that the immediate treatment of 200mg of hydrocortisone was an appropriate response, as getting the steroid into the patient was a priority. Kevin said “Being able to review our actions in responding to this event with Sue, following her training session on adrenal crisis some weeks earlier, has been an invaluable learning experience. This experience will benefit colleagues and myself in delivering a high standard of care to patients with adrenal crisis in the future.”
Kevin Hooper, Paignton Ambulance Station
Sue Cox, Torbay Hospital
In the March 2006 newsletter, Sue Cox, an endocrine nurse at Torbay Hospital, reported how she has worked with the West Country Ambulance Service Trust to develop new protocols for adrenal crisis.
Information correct at the time of publication.
First published in the December 2007 edition of the ADSHG newsletter.