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Autonomic Dysreflexia

Autonomic Dysreflexia. Presented by: Christine Azevdo, RN. Objectives. Definition of Autonomic Dysreflexia Causes Symptoms Treatment Prevention Resources Future Educational Programs. Autonomic Dysreflexia (AD).

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Autonomic Dysreflexia

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  1. Autonomic Dysreflexia Presented by: Christine Azevdo, RN

  2. Objectives • Definition of Autonomic Dysreflexia • Causes • Symptoms • Treatment • Prevention • Resources • Future Educational Programs

  3. Autonomic Dysreflexia(AD) • Autonomic Dysreflexia, or hyperreflexia, is a life-threatening condition that can occur in a person with a spinal cord injury at or above the T6 level. It requires immediate attention. • However, clients with SCI lesions as low as T8 experiencing AD have been reported.

  4. Cause of AD • The primary cause of autonomic dysreflexia is “a noxious stimulus below the level of the SCI that produces an exaggerated and unopposed sympathetic response”. • It is an abnormal response to a problem somewhere in the body below the level of spinal cord injury.

  5. Cause of AD • Anything that may have caused discomfort before the spinal cord injury, may now cause Autonomic Dysreflexia if it occurs below the level of injury. • It is important to note that Autonomic Dysreflexia is a vicious cycle that can’t be broken until the cause is found & removed.

  6. Autonomic Dysreflexia(AD) • Many health care workers and emergency staff may be unfamiliar with Autonomic Dysreflexia; especially if they don’t work with spinal cord injured persons. • Autonomic Dysreflexia usually doesn’t occur with persons with spinal cord diseases such as Multiple Sclerosis and Polio.

  7. Potential Precipitating Factors of Autonomic Dysreflexia • 1) Full or distended bladder (frequently caused by plugged or twisted catheter) • 2) Stool impaction (severe constipation, rectal exam) • 3) Infections (of the bladder etc.) • 4) Tests & procedures (cystoscopy, gyn exam) • 5) Pressure sores (decubiti) & dsg changes • 6) Traumatic pain (severe cuts or broken bones) • 7) Hot and cold temperatures

  8. Potential Precipitating Factors of Autonomic Dysreflexia • 8) Sunburn/Insect bites/blisters • 9) Tight clothes • 10) Pressure on the testicles or penis • 11) Severe menstrual cramps & labor • 12) Stomach ulcers • 13) Some drugs (digoxin etc.) • 14) Ejaculation/Sexual intercourse

  9. Symptoms of Autonomic Dysreflexia • High blood pressure (>20 mmHg above baseline) • SEVERE, POUNDING headache • Seeing spots in front of eyes • Blurred vision • Slow heart rate (in 10% of cases) • Goosebumps above the level of SCI injury • Sweating above level of SCI • Nasal stuffiness

  10. Symptoms of Autonomic Dysreflexia • Anxiety • Bronchospasm or respiratory distress • Cardiac irregularities • Patchy erythema above level of SCI • Metallic taste in the mouth • Seizures • Note: BP can go as high as 330/160

  11. Symptoms ofAutonomic Dysreflexia • Uncontrolled high BP is the most dangerous aspect of Autonomic dysreflexia. If untreated, serious consequences such as: apnea, seizures, stroke, retinal hemorrhage, renal failure, subarachnoid hemorrhage, cardiac arrhythmia, cardiac arrest, or death can occur. Therefore, healthcare providers must be aware of this problem and know how to intervene appropriately.

  12. What to Do • Sit the patient up if they are lying down (this will decrease the blood pressure). • Find & remove the cause (it won’t go away until the cause is corrected). • Check the bladder 1st. If no catheter, catheterize (apply topical anesthetic). But, empty the bladder slowly by lifting the draining end of the catheter. If done too quickly, may cause spasm & raise BP.

  13. What to Do • Check for bowel problems next. If there is stool in the rectum, remove it manually. Apply lidocaine to area to numb it and wait 5 minutes for it to work. This will prevent further stimulation to the area which will cause the BP to go higher.

  14. What to Do • Check for skin problems. Look for cuts, bruises, or ulcers. If there is pressure on skin, reposition. • Remove anything tight ( clothing, wristbands, external catheter tape, shoes, leg bag straps, abdominal binder, condom catheter, and elastic bandages).

  15. Treatment forAutonomic Dysreflexia • When the cause is unknown, notify the MD right away and continue to assess for a cause. • When SBP > 160, 1” nitro ointment to hairless skin above level of injury is usually applied, & if no effect another 1” is applied, (wipe off if SBP <130). • Hydralazine 10mg also used, if no effect after 10 minutes give another Hydralazine 10mg.

  16. Treatment forAutonomic Dysreflexia • Nifedipine 10mg can also be given (avoid bite & swallow technique since there is a risk of abrupt hypotension.) • Monitor BP every 5 minutes until AD is resolved and then every 30 minutes for 4 hours (observe for recurrence within 24 hours of initial episode).

  17. Prevention ofAD • Empty bladder routinely. • Keep catheter draining well. • Routine bowel movements. • Clients at high risk for AD may be placed on a maintenance dose of an antihypertensive medication.

  18. Prevention ofAD • Clients at risk should carry an ID card distributed from the PVA that describes the symptoms, causes, & interventions of AD.

  19. Resources for Autonomic Dysreflexia • For more information on Autonomic Dysreflexia, visit the following websites: • www.pva.orgto obtain the Clinical Practice Guidelines on the Acute Management of Autonomic Dysreflexia: Individuals with Spinal Cord Injury Presenting to Health Care Facilities. • www.spinalcord.uab.edu (Spinal Cord Injury Information Network).

  20. Thanks for your time! 

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