Yes, but typically I'm not giving Solu-Medrol for adrenal insufficiency, I'm using decadron or hydrocortisone.
And from an EMS standpoint, why would you be treating adrenal insufficiency?
IV Solu-Medrol
- Thread starter cannonball88
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Yes, but typically I'm not giving Solu-Medrol for adrenal insufficiency, I'm using decadron or hydrocortisone.
And from an EMS standpoint, why would you be treating adrenal insufficiency?
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EMS sometimes transports pretty sick folks.
And not to speak for Brandon, but I think his comment was directed more towards the general idea of carrying steroids vs. specifically using methylprednisolone for a relative adrenal insufficiency. As in a stress dose.
BTW I'm not aware of any EMS systems that give stress doses or any evidence for it being done prehospital, but there are probably lots of things routinely done in EMS that make less sense.
I'm not saying EMS doesn't transport sick people. But from a 911 standpoint, adrenal insufficiency isn't going to be treated in the field. And from an IFT standpoint, I'd assume (yes, I know what happens when you assume), that it would have been given in the hospital already.
Tbh, even in the ED, I've only treated 2 adrenal insufficiency patients in 8 years. And the endocrinologists have told me in the past that the Solu-Medrol isn't their preferred medication, decadron or hydrocortisone is.
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Again, I *think* Brandon was referring more to corticosteroids in general being potentially useful in the field; not necessarily saying that it should be standard practice to give methylprednisolone prehospital when adrenal insufficiency is suspected.
And I'm not saying that I think it should be common practice, either. But I'm also not sure it's the worst idea in the world to try giving a stress dose to a hypodynamic patient with a history of Addison's disease, or to someone who looks like they've been really sick for a few days and is nearing cardiovascular collapse.
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Yup. I've given Solu-Medrol for precisely the above situation. Patient was on vacation, known to have Addison's, hypotensive, and hardly responsive. We had a 40 minute or so transport, so I ran the idea by the medical control doc and he was all for it. Worked out just fine.
Brandon O
Puzzled by facies
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As Remi said, I wasn't referring to specific corticosteroid choices. But there is evidence that early stress dosing (i.e. prehospital vs ED time is relevant) makes a difference to outcomes. Massachusetts started carrying methylpred for that reason and I believe other regions have done the same.
The opinion on the street seemed to be "we'll never use this" since the protocol was to give it for "known adrenal insufficiency," but that's not so wild -- you just have to hear about it in their PMH. People just didn't understand the importance.
The opinion on the street seemed to be "we'll never use this" since the protocol was to give it for "known adrenal insufficiency," but that's not so wild -- you just have to hear about it in their PMH. People just didn't understand the importance.
Brandon O
Puzzled by facies
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And FWIW I agree Solumedrol isn't usually the drug of choice so not sure why that's what they settled on. Maybe logistical reasons.
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We have some agencies here carrying solu-cortef for that, but I think much of that came from a community push.
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It probably is for logistical reasons... the SM we have in our ED isn't mixed until it's used so it can be stored for quite a while. IIRC once it's mixed we have maybe a day to use it.
BassoonEMT
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Don't know about out there, but by me some placed carry it as the preferred treatment for adrenal insufficiency. But solu-medrol is also acceptable, just not preferred. That's the only protocol it's written in.
18G
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EMS is the point of first medical contact. Our job is to treat the patient as a whole and to deliver whatever care is appropriate while we are with them. I believe in getting medications onboard sooner than later when they are indicated and can help change a patient's trajectory. Solu-Medrol is one of these type of medications. I totally agree with what John said which is patients do not receive immediate treatment upon rolling into the ED. It is often a good 20-30mins before meds get administered. One study found that it took an average of 70mins for an EMS arrived patient to receive their first dose of pain medication. So, if you're sitting in the ambulance bay at the ED, take an extra minute while you're still 1:1 with the patient and administer the medication.
I agree with the Solu-Medrol for Addisons crisis. While not the preferred steroid, it does work.
I agree with the Solu-Medrol for Addisons crisis. While not the preferred steroid, it does work.