免费在 GitHub 公开

enda-emergency-hc-adrenal-crisis

Recommends immediate IV hydrocortisone stress dosing for patients with suspected adrenal crisis presenting with severe adrenal insufficiency symptoms such as hypotension, hyponatremia, hyperkalemia, or acute abdominal pain. Use when clinician observes signs of adrenal crisis (e.g., syncope, delirium, marked abdominal tenderness) prior to diagnostic test results.

中文简介正在准备中。当前显示原文说明。

dromlakhani/MD2SKILL

实测评分未实测

查看安装方法

包含的文件（1）

SKILL.md2.8 KB

SKILL.md（原文）

安装前可以查看交给 AI 代理的指令内容。

Administer Emergency IV Hydrocortisone for Suspected Adrenal Crisis

STEP 1 — Gather Information

Collect history of adrenal insufficiency or steroid use, recent stressors (infection, trauma, surgery), symptoms (weakness, abdominal pain, nausea/vomiting), vital signs (BP, HR, RR, temp), point-of-care labs (Na, K, glucose), and if available, baseline cortisol and ACTH before steroids. If severe adrenal insufficiency symptoms or adrenal crisis suspected, proceed to Step 2; otherwise, consider alternative diagnoses and do not administer emergency hydrocortisone.

STEP 2 — Rule In / Rule Out

Is systolic blood pressure <90 mmHg or MAP <65 mmHg, or presence of altered mental status (confusion, delirium, syncope)? If yes → proceed to Step 3 (adrenal crisis likely). If no → consider less severe adrenal insufficiency; hold emergency hydrocortisone and pursue outpatient management.

STEP 3 — Classify or Stratify

Determine patient age and weight to select stress dose: Adults (≥18 years): 100 mg IV hydrocortisone bolus; Children: 50 mg/m2 IV hydrocortisone bolus (max 100 mg). Proceed to administer the calculated dose.

STEP 4 — Decide

Administer the calculated IV hydrocortisone bolus immediately, followed by continuous infusion of 200 mg hydrocortisone over 24 hours (or 50 mg IV every 6 hours) and initiate isotonic fluid resuscitation (e.g., 1 L normal saline bolus). Reassess clinically and continue stress dosing until stable.

Clinical Guardrails / Mimics / Pitfalls

Do not delay treatment awaiting ACTH stimulation test results; avoid dexamethasone as first-line agent due to lack of mineralocorticoid activity; ensure concurrent fluid resuscitation with isotonic saline to correct hypotension and hyponatremia; monitor for hypoglycemia and administer dextrose if needed; do not give oral hydrocortisone if patient is vomiting or unable to tolerate PO.

Concrete Clinical Example

A 48-year-old woman with known primary adrenal insufficiency presents with sudden vomiting, abdominal pain, hypotension 85/55, Na 128 mmol/L, K 5.6 mmol/L, glucose 48 mg/dL. She receives 100 mg hydrocortisone IV bolus, followed by 200 mg hydrocortisone over 24h via continuous infusion and 1 L normal saline bolus. Blood pressure improves to 118/70 within 2 hours, and symptoms resolve.

Source: Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2015-1710

评价

还没有评价。欢迎分享你的使用感受。

无需登录即可发表。欢迎分享使用感受、提问，或说明在哪些环境下无法运行。

还没有评论。来写第一条吧。

同一仓库的技能

780g-pump-adjustment

免费

Guide pump setting adjustments for the MiniMed 780G system based on CareLink data, using Medtronic's 3-step follow-up workflow. Use when a clinician has CareLink data for a 780G patient and wants to know what to change — which setting, by how much, and how to program it. Triggers include: "what do I adjust", "how to fix high TIR", "how to reduce hypos", "adjust ICR/ISF/basal", "SmartGuard settings", "780G pump settings review", or any question about optimising 780G therapy after reviewing a download.

中文简介正在准备中。当前显示原文说明。