NOTFALL (Addison-Krise) – Notfall Infos

Instructions in the event of an Addisonian crisis

ENDOCRINOLOGICAL EMERGENCY

ACT FIRST THEN DISCUSS

The short version

for emergency services:

Susanne Knipping needs a right adrenalectomy and therefore requires a Daily steroidReplacement therapy

You must immediately 100 mg hydrocortisone per injection be administered

In case of doubt not too much during dosing

This emergency kit contains hydrocortisone ampoule / disposable syringe / cannulas

Yellow cap the hydrocortisone ampoule Press down firmlyso that dry substance is mixed with solvent

Ampoule Do not shakebut mix in a rolling motion until a clear solution arises

Draw up the syringe with a long cannula

Attach short cannula

In the thigh muscle inject

Further hydrocortisone and electrolyte infusions take place in the intensive care unit

More details for the emergency services in the Patient information (health card insurance number required)

ENDOCRINOLOGICAL EMERGENCY

SECTION FIRST,
THEN EXECUTE

Step-by-step instructions

Emergency call 112

If the Addisonian crisis has occurred, Susanne will not be able to make a clearly formulated emergency call. For this reason, a reference text is provided here that contains all the necessary information for calling an emergency doctor. Italicised text passages please select according to the situation:

Hello, my name is _________________

We are located at _____________________

With me is Susanne Knipping
who requires daily steroid replacement therapy

It has now been recognised due to
Vomiting / diarrhoea / shock / fainting / accident
clear signs of an emerging
and thus life-threatening adrenal crisis

You need immediately 100mg hydrocortisone per injection administered.

The hydrocortisone is available / must be brought along*

Susanne then has to go to hospital for observation and saline infusion...preferably with an endocrinology department.

= alternatively, in an emergency, if hydrocortisone is not available, another "cortisone" preparation can be used: e.g. prednisolone in Solu-Decortin H® (5 mg prednisolone ≙ 20 mg hydrocortisone)

Hydrocortisone emergency kit

This emergency kit should be kept in your handbag, laptop bag, glove compartment or large bathroom cabinet

It includes

1 strip of hydrocortisone (10 mg) tablets
1 pack of Rectodelt ® 100 mg suppositories
1 syringe set (hydrocortisone ampoule (100 mg) / disposable syringe / needles)

The syringe set contains

1 ampoule of hydrocortisone 100mg
1 disposable syringe 2 ml
1 cannula Ø 0.90 x 50 mm 18 G x 1½
(wind-up - yellow)
1 cannula Ø 0.40 x 12 mm 27 G x ½
(for spraying - grey | alternatively 26 G x ½ - brown)

Prepare syringe

Remove the syringe and the longer yellow Cannula from the packaging.
The quickest way to do this is to press both through the paper.
Attach the cannula to the syringe.
Please leave the protective cap on the cannula.
Put the prepared syringe to one side.

Tap the hydrocortisone ampoule lightly on a firm surface so that the dry substance is loosened.
Place the ampoule upright on a firm surface.
Press firmly on the yellow plastic cap with your thumb so that the solvent enters the lower chamber of the ampoule to the dry substance
(solvent mixes with the powder!).

Roll the ampoule back and forth in the palms of your hands DO NOT SHAKE - until the powder has completely dissolved.
A clear solution must be found!
Remove the small yellow protective cap from the centre of the yellow plastic cover.

Place the long yellow cannula on the syringe and remove the protective cap
Draw up the syringe completely with air.
Insert the cannula with the syringe vertically and in the centre through the rubber stopper.
Press the air into the ampoule, the syringe will partially fill due to the overpressure.
Draw up the entire contents of the ampoule into the syringe.
Make sure that the tip of the cannula is always in the liquid.
It is normal for a small amount of liquid to remain in the ampoule.
Remove the filled syringe from the long cannula while it is still in the ampoule.

Now set the shorter grey cannula onto the syringe and remove the protective cap.
Hold the syringe vertically upwards and tap lightly against the syringe to allow any air in the syringe to rise to the top.
Now press gently on the plunger of the syringe until a drop of liquid emerges from the cannula.

Injection (preferably by the emergency physicians)

The best injection site is the centre of the outer thigh.
Tighten the skin with the non-dominant hand and hold the syringe at a 90° angle to the skin surface with the other hand.
Insert the needle quickly and completely into the skin and press the plunger of the syringe slowly downwards until the entire contents of the syringe have been injected.
Pull the syringe out of the skin quickly and press on the injection site with a clean cloth.
If there is no hinged protective cap, dispose of the used cannula in a puncture-proof container (e.g. screw-top jar).