scholarly journals Case Report: The experience of using Etomidate in the management of severe Cushing's disease and MRSA bacteraemia in a district general hospital in the United Kingdom

2018 ◽  
Author(s):  
Stephanie Wong ◽  
Yew Wen Yap ◽  
Prakash Narayanan ◽  
Christina Daousi ◽  
Mohammad Al-Jubouri ◽  
...  
2019 ◽  
Vol 30 (10) ◽  
pp. 301-308
Author(s):  
Sonia Ike ◽  
Chijioke Ikechi ◽  
Jaideep Rait ◽  
Ankur Shah

The Coronavirus pandemic has caused major change across the world and in the National Health Service. In order to cope and help limit contagion, numerous institutions recognised the need to adjust clinical practice quickly yet safely. In this paper, we aim to describe the changes implemented in a general surgery department at a district general hospital in the United Kingdom. Across the surgical specialties, frameworks, protocols and guidelines have been established locally and nationally. The aerosol generating procedures involved in general surgery required us to alter our daily activities. Modifications to patient management were necessary to try and reduce viral spread. Staff wellbeing was heavily promoted in order to help maintain the frontline workforce. A holistic approach was required.


Author(s):  
Stephanie Wei Ping Wong ◽  
Yew Wen Yap ◽  
Ram Prakash Narayanan ◽  
Mohammad Al-Jubouri ◽  
Ashley Grossman ◽  
...  

Summary We report our experience on managing a case of florid Cushing’s disease with Methicillin-resistant Staphylococcus aureus (MRSA) sepsis using intravenous etomidate in the intensive care unit of a UK district general hospital. Learning points: Severe Cushing’s syndrome is associated with high morbidity and mortality. Etomidate is a safe and effective medical therapy to rapidly lower cortisol levels even in the context of severe sepsis and immunosuppression. Etomidate should ideally be administered in an intensive care unit but is still feasible in a district general hospital. During treatment with etomidate, accumulation of serum 11β-deoxycortisol (11DOC) levels can cross-react with laboratory cortisol measurement leading to falsely elevated serum cortisol levels. For this reason, serum cortisol measurement using a mass spectrometry assay should ideally be used to guide etomidate prescription.


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