Which protocol is indicated for acute adrenal crisis?

• A. Protocol 27
• B. Protocol 21
• C. Protocol 26
• D. Protocol 32

Answer: (C)

Acute adrenal crisis is a life-threatening emergency caused by a sudden shortage of cortisol, leading to shock, dehydration, and severe illness. The protocol for this scenario is built around rapid recognition and definitive treatment of the hormonal deficiency plus aggressive stabilization. It calls for establishing and maintaining a clear airway, providing high-flow oxygen as needed, securing IV access, and starting isotonic fluids to address circulating volume and perfusion. Crucially, it includes glucocorticoid replacement (such as hydrocortisone) when adrenal crisis is suspected or in a patient with known adrenal insufficiency, along with guidance to contact medical control for dosing and further orders. This approach directly targets the underlying deficit and the hemodynamic instability that defines the crisis, making it the most appropriate protocol for this situation. Other protocols address different emergencies and do not cover endocrine-based glucocorticoid treatment, so they aren’t suitable for suspected adrenal crisis.