Adrenal Crisis-Congenital Adrenal Hyperplasia (CAH) - Revision history

JenniferH: /* Pediatric Adrenal Crisis with Hypopit/Congenital Adrenal Hyperplasia */

2020-12-14T17:54:22Z

Pediatric Adrenal Crisis with Hypopit/Congenital Adrenal Hyperplasia

← Older revision		Revision as of 17:54, 14 December 2020
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	*Get accucheck glucose. If glucose result is unknown (ie machine not working), low or undetectable give instaglucose per table. Repeat glucose 15min after giving the glucose gel to confirm that it has normalized		*Get accucheck glucose. If glucose result is unknown (ie machine not working), low or undetectable give instaglucose per table. Repeat glucose 15min after giving the glucose gel to confirm that it has normalized
	*Give 20ml/kg NS bolus quickly as possible.		*Give 20ml/kg NS bolus quickly as possible.
	*Give dexamethasone IM per table, prescribed home emergency solucortef dose IM or give solucortef per table below		*Give dexamethasone IM per table, prescribed home emergency solucortef dose IM or give solucortef per table below (see [https://www.chop.edu/video/solu-cortef-emergency-injection Solu-cortef Emergency Injection] video)
	*Monitor hemodynamics, BP and glucose q1h until medevac arrives.		*Monitor hemodynamics, BP and glucose q1h until medevac arrives.
	*Continue 1.5 x maintenance NS IV		*Continue 1.5 x maintenance NS IV

JenniferH at 12:26, 20 November 2020

2020-11-20T12:26:58Z

← Older revision		Revision as of 12:26, 20 November 2020
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	*Use supportive measures as needed		*Use supportive measures as needed

	[[Practicing Medicine in Bush Alaska—Some ABCs#Congenital Adrenal Hyperplasia (CAH)\|~~General Information about~~ CAH]]
			[[Practicing Medicine in Bush Alaska—Some ABCs#Congenital Adrenal Hyperplasia (CAH)\|YKHC Wiki CAH page]]
			<br/>[[Emergency RMT Scenarios and Responses]]

JenniferH at 07:51, 19 September 2019

2019-09-19T07:51:35Z

← Older revision		Revision as of 07:51, 19 September 2019
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	*Establish intravenous access with a large-gauge needle.		*Establish intravenous access with a large-gauge needle.
	*Get accucheck glucose and give instaglucose 15-20 gms (1 tube) if needed		*Get accucheck glucose and give instaglucose 15-20 gms (1 tube) if needed. Repeat every 15 minutes until symptoms have resolved and glucose is >60.
	*Infuse 2 to 3 liters of saline as quickly as possible.		*Infuse 2 to 3 liters of saline as quickly as possible.
	*Give dexamethasone 4 mg IM.		*Give dexamethasone 4 mg IM.
	*Continue NS IV fluid hydration		*Continue NS IV fluid hydration
	*~~Frequent~~ hemodynamic monitoring and measurement ~~glucose~~ to avoid fluid overload and hypoglycemia		*Continue hemodynamic monitoring and glucose measurement q1h until medevac arrives to avoid fluid overload and recurrent hypoglycemia


	==Pediatric Adrenal Crisis with Hypopit/Congenital Adrenal Hyperplasia==		==Pediatric Adrenal Crisis with Hypopit/Congenital Adrenal Hyperplasia==

JenniferH at 01:41, 11 September 2019

2019-09-11T01:41:31Z

← Older revision		Revision as of 01:41, 11 September 2019
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	*Give 20ml/kg NS bolus quickly as possible.		*Give 20ml/kg NS bolus quickly as possible.
	*Give dexamethasone IM per table, prescribed home emergency solucortef dose IM or give solucortef per table below		*Give dexamethasone IM per table, prescribed home emergency solucortef dose IM or give solucortef per table below
	*Monitor hemodynamics, BP and glucose ~~every hour~~ until medevac arrives.		*Monitor hemodynamics, BP and glucose q1h until medevac arrives.
	*Continue 1.5 x maintenance NS IV		*Continue 1.5 x maintenance NS IV
	*Use supportive measures as needed		*Use supportive measures as needed

	[[Practicing Medicine in Bush Alaska—Some ABCs#Congenital Adrenal Hyperplasia (CAH)\|General Information about CAH]]		[[Practicing Medicine in Bush Alaska—Some ABCs#Congenital Adrenal Hyperplasia (CAH)\|General Information about CAH]]

JenniferH at 01:39, 11 September 2019

2019-09-11T01:39:31Z

← Older revision		Revision as of 01:39, 11 September 2019
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	==Pediatric Adrenal Crisis with Hypopit/Congenital Adrenal Hyperplasia==		==Pediatric Adrenal Crisis with Hypopit/Congenital Adrenal Hyperplasia==
	[[file:instaglucose-sb.png\|right\|350px]]		[[file:instaglucose-sb.png\|right\|350px]]
			[[file:Dexamethasone_Stress_Dose.png\|right\|350px]]
	Shock, with hypotension, hypovolemia and possible nonspecific symptoms such as anorexia, nausea, vomiting, abdominal pain, weakness, fatigue, lethargy, fever, confusion, or coma		Shock, with hypotension, hypovolemia and possible nonspecific symptoms such as anorexia, nausea, vomiting, abdominal pain, weakness, fatigue, lethargy, fever, confusion, or coma

	*Establish intravenous access.		*Establish intravenous access.
	*Get accucheck glucose. If glucose result is unknown (ie machine not working), low or undetectable give instaglucose per table		*Get accucheck glucose. If glucose result is unknown (ie machine not working), low or undetectable give instaglucose per table. Repeat glucose 15min after giving the glucose gel to confirm that it has normalized
	*Give 20ml/kg NS bolus quickly as possible.		*Give 20ml/kg NS bolus quickly as possible.
	*Give dexamethasone IM per table, prescribed home emergency solucortef dose IM or give solucortef per table below		*Give dexamethasone IM per table, prescribed home emergency solucortef dose IM or give solucortef per table below
	*~~Frequent hemodynamic~~, BP and glucose ~~monitoring~~.		*Monitor hemodynamics, BP and glucose every hour until medevac arrives.
	*Continue 1.5 x maintenance NS IV		*Continue 1.5 x maintenance NS IV
	*Use supportive measures as needed		*Use supportive measures as needed

	[[Practicing Medicine in Bush Alaska—Some ABCs#Congenital Adrenal Hyperplasia (CAH)\|General Information about CAH]]		[[Practicing Medicine in Bush Alaska—Some ABCs#Congenital Adrenal Hyperplasia (CAH)\|General Information about CAH]]

JenniferH at 22:56, 10 September 2019

2019-09-10T22:56:53Z

← Older revision		Revision as of 22:56, 10 September 2019
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	==Pediatric Adrenal Crisis with Hypopit/Congenital Adrenal Hyperplasia==		==Pediatric Adrenal Crisis with Hypopit/Congenital Adrenal Hyperplasia==
			[[file:instaglucose-sb.png\|right\|350px]]
	Shock, with hypotension, hypovolemia and possible nonspecific symptoms such as anorexia, nausea, vomiting, abdominal pain, weakness, fatigue, lethargy, fever, confusion, or coma		Shock, with hypotension, hypovolemia and possible nonspecific symptoms such as anorexia, nausea, vomiting, abdominal pain, weakness, fatigue, lethargy, fever, confusion, or coma

	*Establish intravenous access.		*Establish intravenous access.
	*Get accucheck glucose. If glucose result is unknown (ie machine not working), low or undetectable give instaglucose per table ~~below~~		*Get accucheck glucose. If glucose result is unknown (ie machine not working), low or undetectable give instaglucose per table
	*Give 20ml/kg NS bolus quickly as possible.		*Give 20ml/kg NS bolus quickly as possible.
	*Give dexamethasone ~~(0.7mg/kg)~~ IM, prescribed home emergency solucortef dose IM or give solucortef per table below		*Give dexamethasone IM per table, prescribed home emergency solucortef dose IM or give solucortef per table below
	*Frequent hemodynamic, BP and glucose monitoring.		*Frequent hemodynamic, BP and glucose monitoring.
	*Continue 1.5 x maintenance NS IV		*Continue 1.5 x maintenance NS IV

JenniferH at 22:53, 10 September 2019

2019-09-10T22:53:09Z

@@ Line 4: / Line 4: @@
 -----
 Acute adrenal crisis presents as vomiting, diarrhea, dehydration, hypotension and shock. Crisis can be precipitated by illness, trauma and hyperthermia.
-*'''''If you get a call on a pediatric patient with CAH who is in crisis, find out if the caretakers have a dose of IM Solucortef for emergencies and give this ASAP'''''.
-*Make arrangements for medevac.
+==Adult Adrenal Crisis==
-*If the patient has no emergency solucortef available, you can give dexamethasone from the village formulary
+Shock, with hypotension, hypovolemia and possible nonspecific symptoms such as anorexia, nausea, vomiting, abdominal pain, weakness, fatigue, lethargy, fever, confusion, or coma
 [[Practicing Medicine in Bush Alaska—Some ABCs#Congenital Adrenal Hyperplasia (CAH)|General Information about CAH]]

JenniferH at 00:52, 31 August 2019

2019-08-31T00:52:54Z

← Older revision		Revision as of 00:52, 31 August 2019
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	[[image:All Emergency RMT.png\|750px]]		[[image:All Emergency RMT.png\|750px]]

			[[media:pediatric critical care guide.pdf\|Pediatric Critical Care Guide]]
			-----
	Acute adrenal crisis presents as vomiting, diarrhea, dehydration, hypotension and shock. Crisis can be precipitated by illness, trauma and hyperthermia.		Acute adrenal crisis presents as vomiting, diarrhea, dehydration, hypotension and shock. Crisis can be precipitated by illness, trauma and hyperthermia.
	*'''''If you get a call on a pediatric patient with CAH who is in crisis, find out if the caretakers have a dose of IM Solucortef for emergencies and give this ASAP'''''.		*'''''If you get a call on a pediatric patient with CAH who is in crisis, find out if the caretakers have a dose of IM Solucortef for emergencies and give this ASAP'''''.

JenniferH at 00:15, 31 August 2019

2019-08-31T00:15:49Z

← Older revision		Revision as of 00:15, 31 August 2019
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			[[image:All Emergency RMT.png\|750px]]

	Acute adrenal crisis presents as vomiting, diarrhea, dehydration, hypotension and shock. Crisis can be precipitated by illness, trauma and hyperthermia.		Acute adrenal crisis presents as vomiting, diarrhea, dehydration, hypotension and shock. Crisis can be precipitated by illness, trauma and hyperthermia.
	*'''''If you get a call on a pediatric patient with CAH who is in crisis, find out if the caretakers have a dose of IM Solucortef for emergencies and give this ASAP'''''.		*'''''If you get a call on a pediatric patient with CAH who is in crisis, find out if the caretakers have a dose of IM Solucortef for emergencies and give this ASAP'''''.

JenniferH: Created page with "Acute adrenal crisis presents as vomiting, diarrhea, dehydration, hypotension and shock. Crisis can be precipitated by illness, trauma and hyperthermia. *'''''If you get a ca..."

2019-08-25T22:13:33Z

Created page with "Acute adrenal crisis presents as vomiting, diarrhea, dehydration, hypotension and shock. Crisis can be precipitated by illness, trauma and hyperthermia. *'''''If you get a ca..."

New page

Acute adrenal crisis presents as vomiting, diarrhea, dehydration, hypotension and shock. Crisis can be precipitated by illness, trauma and hyperthermia.
*'''''If you get a call on a pediatric patient with CAH who is in crisis, find out if the caretakers have a dose of IM Solucortef for emergencies and give this ASAP'''''.
*Make arrangements for medevac.
*If the patient has no emergency solucortef available, you can give dexamethasone from the village formulary
[[Practicing Medicine in Bush Alaska—Some ABCs#Congenital Adrenal Hyperplasia (CAH)|General Information about CAH]]