Adrenal Crisis, Records, Debrief, and Speaking Up

Adrenal crisis is uncommon but life-threatening. It can occur in people with adrenal insufficiency, Addison's disease, pituitary disease, or those dependent on steroids. Dental nurses may first recognise risk from a steroid emergency card, the medical history, collapse, severe weakness, vomiting, abdominal pain, confusion, low blood pressure, or a patient saying they need hydrocortisone urgently.

NICE and the Society for Endocrinology advise treating suspected adrenal crisis without delay because emergency hydrocortisone can be life-saving. Practices do not always stock hydrocortisone, so staff should focus on recognising the emergency, stopping treatment, calling 999, supporting the patient's airway, breathing and circulation, locating any emergency kit or card, and giving a clear handover to ambulance staff.

What to record after any emergency

• Symptoms, trigger, and the patient's medical history or emergency card.
• Times of recognition, 999 call, drugs, oxygen, observations, and ambulance arrival.
• Who led, who called, and who recorded.
• Any equipment problems, delays, or role confusion.
• What was handed over and what follow-up is needed.

A debrief should identify what went well and what needs to change without blaming individuals. Dental nurses must be able to raise concerns about missing equipment, delayed escalation, or other patient-safety issues. Helpful phrases include: "The patient is not recovering as expected", "I think this is a medical emergency; I am calling for help now", and "The emergency kit issue needs action before the next session".

Adrenal crisis systems

After a medical emergency, clear records, restocked equipment, fair debriefing, and staff support are part of patient safety. Silence after a near miss leaves the next patient exposed.