What ambulance professionals need to know in an emergency
Pituitary conditions are considered rare and a paramedic/ambulance technician may only ever see one or two patients with this condition, including those patients who are having an ADRENAL CRISIS.
It is quite usual that an ambulance will be called to help and initially treat the patient before transit to hospital. As a paramedic, you are the most important first line of assistance to ensure that the patient is treated appropriately with an injection of hydrocortisone; this will help to stabilise the patient even before reaching hospital. You can be of vital help to relate the correct clinical details of your patient to the Accident & Emergency Department. This will save precious time so that the patient can receive swift and appropriate ongoing care.
What is hydrocortisone?
Hydrocortisone is a steroid hormone produced by the adrenal gland. It plays a complex role in regulating body functions and is essential for survival.
Hydrocortisone is taken as a replacement for the natural hormone where this is deficient, either because there is a failure of hydrocortisone production by the adrenal gland (Addison’s Disease), or pituitary deficiency of ACTH (the hormone that stimulates the production of hydrocortisone by the adrenal gland). Replacement therapy is also required for people who have congenital adrenal hyperplasia, which is a birth defect. Hydrocortisone is available as tablets, under the trade name Hydrocortisone, containing 10mg or 20mg.
An injection containing 100mg Hydrocortisone is available for emergency situations. For children there are lower dose emergency injections available.
How does a patient take it?
The usual dose is 15 - 20mg orally split over two or three times daily, and depending on their individual endocrinologist’s recommendations. For example: 10mg before rising, 5mg at mid-day and 5mg no later than 6pm.
When would they need to take more hydrocortisone?
If a person becomes ill, is vomiting repeatedly or is involved in an accident, then the body would naturally increase the output of steroid from their adrenals. Therefore, if a person is taking replacement steroid (hydrocortisone) it is essential to mimic the natural response by increasing their dose appropriately.
If the patient is unable to let others know they take replacement hydrocortisone
The patient may be too confused or unconscious to alert you, therefore please look for:
- Medical Talisman - necklace or bracelet which will state hydrocortisone or steroid
- A Pituitary Foundation patient care card in their bag, wallet, pocket or glove compartment of car. If patient is at home, check their fridge for emergency injection, cupboards or bag for hydrocortisone tablets
- Blue Steroid card issued by hospital
- Emergency hydrocortisone injections - for home use
The Foundation recommends all patients taking hydrocortisone should have a 100mg injection kit in their home for emergency use only; this might be in their fridge. However, the patient may not have this injection prescribed for them.
When would a patient need an emergency hydrocortisone injection?
If they cannot absorb their tablets, or their usual replacement wasn’t sufficient for an acute shock or illness, then gradually or perhaps quite quickly the following signs can happen:
- Feel weak, sickly, light headed and be confused
- Have a pale pallor
- Blood pressure would drop
If appropriate emergency hydrocortisone treatment is not given, the patient can lapse into unconsciousness and possible coma. An injection can save the patient’s life.
PITUITARY PATIENT? > TAKING HYDROCORTISONE?> ADRENAL CRISIS? IF YES - INJECT WITH HYDROCORTISONE
Andy Baines, Advanced Paramedic in Cheshire & Merseyside Area, has written an article on Adrenal Insufficiency Improving Paramedic Practice, which has been published in the Journal of paramedic practice. You can download a copy of it here.
Ambulance staff e-learning module developed by the North West England Ambulance Service
This e-learning module was produced by Andy Baines, Advanced Paramedic in Cheshire & Merseyside Area. It is now being used in training for ambulance staff about adrenal crisis and is free to access here
You will need the module password: pituitarydemo