L3 Addisions PDF September 2020

Medical and Surgical Conditions Adrenal Insufficiency and Addison’s Disease  Adrenal Insufficiency/Addison’s Disease Objective Describe the nature and characteristics of Adrenal insufficiency and Explain h...

Medical and Surgical Conditions Adrenal Insufficiency and Addison’s Disease  Adrenal Insufficiency/Addison’s Disease Objective Describe the nature and characteristics of Adrenal insufficiency and Explain how to manage a patient suffering Addisonians crisis © Department of Clinical Education & 2 Standards  Adrenal Insufficiency/Addison’s Disease Prevalence in the UK Autoimmune Addisons affects 1 in 10,000 8,400 diagnosed cases Usually young and middle aged people (Ambulance Care Practice, 2016). ©Clinical Education & Standards 3  Adrenal Insufficiency/Addison’s Disease Adrenal Insufficiency is a rare, potentially deadly but treatable disease. In an acute crisis, the patient's health can deteriorate rapidly and result in death Caroline 2014 ©Clinical Education & Standards 4  Adrenal Insufficiency/Addison’s Disease Primary Also called Addison’s disease. Damage to the adrenal cortex causes them to not be able to make enough cortisol and aldosterone. Secondary Caused by a de-functioning pituitary gland not signalling the adrenal glands to make cortisol. Can also be caused by long term and / or large dosages of Steroid intake. Caroline 2014 ©Clinical Education & Standards 5  Adrenal Insufficiency/Addison’s Disease Addison’s disease is also known as primary adrenal insufficiency The adrenal glands are two small glands that sit on top of the kidneys. They produce two essential hormones: Cortisol Aldosterone. In Addison's disease, the adrenal gland is damaged, and not enough cortisol and aldosterone are produced. Caroline 2014 ©Clinical Education & Standards 6  Adrenal Insufficiency/Addison’s Disease Cortisol and Aldosterone Help regulate blood pressure Help the immune system Balances the effect of insulin Assists the body responding to stress Regulates salts in the blood 7 Adrenal Insufficiency/Addison’s Disease Hyperpigmentation Vitiligo ©Clinical Education & Standards 8  Adrenal Insufficiency/Addison’s Disease Hyperpigmentation © Department of Clinical Education & 9 Standards  Adrenal Insufficiency/Addison’s Disease Cause Incidence % Vomiting 33 History is Diarrhoea 23 Flu-like Illness 11 Major Infection 6 Surgery 6 Blackout/LOC 6 Injury/Severe Pain 4 Shock 4 Other 3 Severe fatigue/inadequate 2 medication Unknown 1 Anxiety/phsycological upset/stress 1 Ambulance Care Practice, 2016 ©Clinical Education & Standards 10  Adrenal Insufficiency/Addison’s Disease Tablet or IM steroid treatment: 40 mg for more than a week. 20 mg or more for two weeks. 5 mg or more for more than 4 weeks. This can affects the body’s own ability to produce Cortisol. This effect can last as long as a year after steroid discontinuation and increase the risk of developing adrenal crisis. Fields,2009 ©Clinical Education & Standards 11  Adrenal Insufficiency/Addison’s Disease Possible triggers of acute exacerbation include: Infection Hypoglycaemia Stress Traumatic injuries Surgery Burns Pregnancy Medical emergencies such as MI Sudden stop to steroid treatment (Hahner. and Allolio, 2009). ©Clinical Education & Standards 12  Adrenal Insufficiency/Addison’s Disease The body is unable to increase cortisol production to respond to the stress levels and may enter a state of crisis. ©Clinical Education & Standards 13  Adrenal Insufficiency/Addison’s Disease Assess and manage ABC symptomatically Maintain SP02 > 94% IV access if indicated – by paramedic 100mg Hydrocortisone IV or IM – Not in AAP scope of practice Manage hypoglycaemia with IV glucose where required – by paramedic ECG Rapid transport to nearest suitable ED facility (Caroline (2014), JRCALC+, National Institute for Clinical Excellence (2017) ©Clinical Education & Standards 14 Adrenal Insufficiency/Addison’s Disease Questions? © Department of Clinical Education & 15 Standards  Adrenal Insufficiency/Addison’s Disease Association of Ambulance Chief Excutives, (2016). UK ambulance services clinical practice guidelines 2016. 1st ed. Class Professional Publishing. Caroline, N. (2014). Nancy Caroline's emergency care in the streets. 1st ed. Sudbury, Mass.: Jones & Bartlett Learning, pp.601 and 611 Fields, T. (2009). Steroid Side Effects: How to Reduce Corticosteroid Side Effects. [online] Hospital for Special Surgery. Available at: https://www.hss.edu/conditions_steroid-side-effects-how-to-reduce-corticosteroid-side-effects.asp [Accessed 9 Mar. 2017]. Hahner, S. and Allolio, B. (2009). Therapeutic management of adrenal insufficiency. Best Practice & Research Clinical Endocrinology & Metabolism, 23(2), pp.167-179. JRCALC + National Institute for Clinical Excellence, (2016). Addison's disease - NICE CKS. [online] Cks.nice.org.uk. Available at: https://cks.nice.org.uk/addisons- disease#!topicsummary [Accessed 9 Mar. 2017]. Postiglione, C. (2013). Adrenal insuffi ciency: Considerations for the prehospital provider. Texas EMS magasine, pp.14 - 29. Mandal, A. (2018), News Medical Life Sciences. Available at: https://www.news-medical.net/health/What-is-Addisons-Disease.aspx [Accessed 6 May 2020] © Department of Clinical Education & 16 Standards