Adrenal Crisis

I've had a busy week. Cardiac arrest, sudden death, diabetic hypo, countless falls and an imminent birth (That we managed to get to hospital just in time. It was close though, she wasn't budging initially but as soon as I opened up the mat pack she shouted "No, not here! I didn't want this!" "Well you've two choices, take some really good breaths on this gas and air and let's get you down to the vehicle or we'll have to deliver here. Your choice." I said. With that she gulped the gas and air and made it to the truck. We were only 2 minutes from the hospital and were there in no time. They had called the midwife but she refused to come out. I phoned maternity and requested one to come out as birth was imminent but then cancelled her as we were en route.)

I was on the car over the weekend and Saturday was spent mostly going to calls but being stood down again. Then 25 minutes towards the end of my shift in comes a call, Sick person, Cat B. "Bugger!" It's not far and en route I get an update. Female with a histroy of Addison's Disease. I'm greeted by the woman's kids who show me into the front room. My patient has been vomiting for 24 hrs plus, unable to keep her oral steroids down and had already given her self her own Hydrocortisone injection 5 hours earlier. She was not good. I needed to get some more steroids into her but her veins were non existent. I tried twice but there was nothing. The ones in her hand were like trying to cannulate an electric cable, tough. I gave up and gave her an IM injection instead. She did say that she had terrible veins and that they always had trouble at hospital. She did ask me to put an IV in her ankle as that is what they usually end up doing in A/E. I said I'd rather not if I can help it. She also had severe abdo pain radiating into the back so I gave her some gas and air. No sign of a crew so I called up control. "Nothing assigned to you yet, why, did you need one then?" "Er yes please, bearing in mind this lady is suffering from an Adrenal crisis and it is potentially life threatening." "OK, we'll get one running." They took ages and my patient was pleading for me to have another go at getting a line in. She wanted some anti-sickness meds and as her BP was low I needed to get some IV fluids going. Her sugar was OK (this can be low in a crisis) and she had good oxygen saturations. The crew arrived and after a little bit of banter (she was in remarkably good spirits despite her condition) we got her onto the truck. Now she was lying down I had a look at the vein in her ankle, it was a beaut. "Right I'll have one attempt and that's it." I said. "Please do, I'd rather you got one in now." She said.

And in it went, 4 vials of bloods, some IV Metoclopramide (she was already taking the oral version) and some IV sodium chloride and they were ready to go. I gave a pre alert to A/E and off she went. The vast majority of my on scene time was taken up waiting for the crew to arrive. I finished 45 minutes late, at time and a half mind you, and it was for a genuine patient so I didn't mind. It didn't help that I left my house keys at home and had to wake my wife up at 1.15 am to let me in. Whoops.

For those non-medical types and trainee techs etc that might read this blog my next post will be a brief overview of what Adrenal crisis and Addison's disease is about. Stay tuned.