Your emergency injection kit
WHAT IT SHOULD CONTAIN, WHEN AND HOW TO USE IT
The emergency injection kit can be a confusing and intimidating subject. Many people with adrenal insufficiency have never handled a syringe before. Knowing what you need, as well as when and how to use it, can build confidence and keep you safe in emergencies.
All patients with adrenal insufficiency need an emergency injection kit.
Anyone is at risk of a sudden accident or trauma. Shock or injury creates an immediate need for more cortisol. Without emergency treatment, death can occur in as little as 30 minutes. It’s important to discuss a crisis plan with your doctor. Here’s an excellent paper to help start the conversation. The first paragraph says it all.
http://www.eje-online.org/content/172/3/R115.full
There are two ways the emergency injection helps when you have a crisis:
One, it bypasses the gut when you have extreme nausea or vomiting. If you can’t keep your tablets down, you need to use the injection.
Two, it gets delivered into the blood stream rapidly. Tablets take 30 to 45 minutes to get into your blood stream. If your low cortisol symptoms have become severe, you may need to inject.
At its most basic, your kit should contain a vial of Solu-cortef or dexamethasone, a syringe, and alcohol wipes.
Syringe size should be 3ml, 22 or 23 gauge, and 1′ to 1 1/2″ needle length. You will need a script for 2 vials and 6 syringes, in case of malfunction. Most pharmacies will include the syringes, but some don’t. It’s easier to have your doctor write them on the script to avoid confusion when getting it filled. In some countries instructions say to change the needle mid-procedure. One needle is all that’s needed, and changing it before injecting is difficult in an emergency. Instructions for injecting should also be included. This one has clear pictures.
https://www.adrenalinsufficiency.org/wp-content/uploads/2020/04/AIC_Emergency_Injection.pdf
The container you choose to hold your emergency supplies should be easy to identify as emergency medication.
Bright colors and large letters or medical icons help when time is important. Here’s a few choices.
https://www.etsy.com/…/medical-alert-pouch-first-aid-kit-epi
https://www.zazzle.com/adrenal_insufficiency_bag-2233090435…
The next step is to learn how to use your emergency kit.
There are many injection videos online. Ask a friend or close relative to watch the video with you and be prepared to help in an emergency. This video from the SUCCEED Clinic gives a clear, easy to follow demonstration. It is ok to inject through clothing if necessary.
https://www.youtube.com/watch?v=nuJ9Wj_eb4U
Probably the most confusing part is knowing when to use it.
A crisis can happen suddenly from a traumatic event, such as a car accident. Or, it can happen over the course of a few days when extra activity or stress depletes cortisol. When sudden trauma occurs, the choice is obvious. When accumulated stressors lead to a low cortisol “crash” it is much harder.
Note: Each person has their own pattern from low cortisol to crisis.
Low cortisol symptoms may include nausea, headache, body ache, high or low blood pressure, chills or sweats, and anxiety or confusion. Journaling your dose amounts, times, blood pressure, and symptoms can help you identify your own unique pattern. The goal is to stress dose appropriately and prevent reaching the crisis stage.
The progression of your symptoms can help you decide if injection is appropriate. This is why it is important to know your pattern of symptoms. If you are having this type of crisis regularly, you may be under replaced. An adequate baseline and stress dosing when necessary can reduce this type of crisis and should be discussed with your doctor.
We hope this information demystifies the emergency injection procedure. We all want to avoid a crisis. Knowing what to do if it happens can reduce the fear and keep you safe.