Transcript Autonomic Dysreflexia - Duke of Cornwall Spinal Treatment

Autonomic Dysreflexia
Anne Seaman
Lead Nurse
Duke of Cornwall Spinal Treatment Centre
What is Autonomic Dysreflexia?
Can occur quickly
Is a life threatening medical
emergency
Dysreflexia
First described in 1917,
It is a protective mechanism that tells the
person that something is wrong
Important to view it as a positive warning sign
Also known as autonomic hyperreflexia,
Who is at risk?
Occurs in 83-85% of tetraplegic and high
level paraplegic persons injured (T6 and
above)
If is going to occur, it usually begins
within the first few months following
spinal shock
What happens
 SCI results in the nerve pathways to the brain are
interrupted.
 When there is pain or discomfort below the level of your
SCI it triggers a nervous system reflex response
 This begins a rapid increase in your blood pressure
 This will continue until the cause is found and treated
Possible Consequences of AD
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Retinal haemorrhage in the eye
Apnoea - breath holding
Stroke
Renal (Kidney) failure
Subarachnoid (Brain) haemorrhage
Seizures (Fits)
Cardiac dysrhythmias (Heart changes)
Cardiac arrest
Death
All are rare
Prevention of AD
Good personal care
Careful bladder and bowel management
Good education
Expert Patient - in control
Most Common Causes?
Research shows that the most common causes
are:
1 over distended bladder
2 over distended bowel
(Ceron & Rakowski-Reinhardt 1991, Dunn 1991, Finocchiaro &
Herzfeld 1990, McGuire & Kumar 1986 cited Adsit & Bishop 1995)
Most Common Triggers
Distended bladder
Distended bowel
Skin breakdown
UTI
Other causes of pain or discomfort
Other Possible Triggers
 Ingrown toenails
 Burns and Sunburn
 External temperature
 SIC
extremes
 Enemas
 Clothing or shoes too tight  Fractures
 Digital stimulation of the  Ovarian cyst
bowel
 DVT & PE
 Bladder spasm and stones  Perforated gastric ulcer
 Spasticity
 Heterotrophic Ossification
 Sphincter bladder
 Orthastic hypotension
dyssynergia
 Oesophageal reflux
 Appendicitis
 Orgasm
Response to Raised BP
The body does try to reduce the BP,
only able to do so above the level of injury,
which produces the well recognised
symptoms of autonomic dysreflexia
Signs and Symptoms
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Headache - sudden & thumping
Flushed face – vasodilitation
Blotching of the skin – erythema
Goose bumps below the level of the lesion
Pallor below the level of the lesion
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Increased blood pressure
Bradycardia
Profuse sweating
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Nasal stuffiness
Fear
Patient Specific Symptoms
Some patients may not experience the
common symptoms,
particularly the thumping headache
May complain of a ‘tight chest’ instead
Other Signs and Symptoms
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Increased spasm and spasticity
Nausea
Respiratory difficulties
Heart beat changes
Impending sense of doom
Vision changes
Metallic taste in the mouth
Treatment
Are you at risk of AD?
 Level of SCI ? T6 or above
 Extent of SCI
?complete/?incomplete
 Previous episodes
 Usual cause
 Post SCI new normal BP
Treatment
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Carers or you need to act quickly & calmly,
Enlist help if needed
Sit upright if in bed (helps to lower BP)
BP monitored every 3-5 mins in hospital
Loosen tight clothing & binders
Assess for cause – bladder & bowel first
Prepare for catheter change or bowel care
Find Cause: Bladder
Check urine in drainage bag
Full, empty and monitor
Empty, ?when last emptied
Check for kinks in tubing
Check for signs if catheter is dislodged
Any sign of haematurea?
Catheter blocked? Change it
Find Cause: Bowel
Last bowel care, ? Result – good/small
Lie on left side (head raised)
PR check
If full will need manual evacuation
Local anaesthetic gel (3 mins)
Gentle Manual Evacuation (ME)
Let AD resolve and then perform usual bowel
care
Other Cause?
?Ingrown toe nail
?Pressure ulcer
Give analgesia
? Give Nifedipine
Call GP, will need treatment and possibly
Nifedipine SR
Treatment
 Administer
 Nifedipine 5mg crush and swallow
 Or GTN 300Micrograms/nasal spray
(Only if diastolic BP is greater than 100mmHg)
Patient should have a supply
 If this is unsuccessful and cause is not found
inform a Dr/GP/go to ED as Phentolamine
5-10mg IV may be required
 Time will be running out
Patient Information
Alert card
Carry medication
Care manual
Rehabilitation Process
Assessment
Education
Patient, Family, Friends, Carers,
Lesson Plan
Skills development
Skills assessment
Independence
Teaching others
Rehabilitation Process
Developing skills
Recognition
Self assessment – find cause
When to take medication
Change catheter
Bowel care
Skin inspection
Monitoring
Care plan
Diary
AD Diary
 This diary is intended for you to use and keep as a record of your
episodes autonomic dysreflexia. The intention is not for you to keep
records indefinitely, but until you feel confident in your ability to
recognise your symptoms together with any trends in the causes to
help you to prevent further episodes.
 Name:
 Level of SCI …………………. Complete
SCI ……………
 Normal BP…………/…………….
Incomplete
Date of
Date of Autonomic Dysreflexia episode ………………………..
Symptoms: Put an ‘X’ in the box of all the symptoms you experienced.
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Pounding headache
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Heavy sweating
Blurred vision
Tight chest
Blotchy/flushed skin above SCI
Goose bumps
Anxiety/fear
Difficulty breathing
Other:
 Cause:
Comments:…………………………..…………………..
 Did you need medication?
Yes No
 What did you take? ………... Dose(s) ……………….
 Did you have any difficulties managing the episode?
 Yes
 No
 Comments: …………………….………………………..
AD Kit
It is advisable to carry suitable equipment
 going out
 on holiday
If you out and unable to find a suitable place to manage
an episode of AD call 999 for help.
In your local area HAVE A PLAN.
Catheter Supplies
 Hand wipes or gel
 Syringe to remove catheter if using an indwelling
catheter
 Spare catheter correct size
 Bladder syringe
 Insertion supplies including hand wipes and gloves
 Sterile syringe to put water into the balloon, sterile
water
 Disposal bag
 Spare clothing if you usually bipass the catheter/leak
Bowel Care Supplies
 Latex gloves
 Polyethylene gloves
 Anaesthetic lubricating gel
 Wet wipes (baby wipes), tissues
 Disposal bag
 Spare clothing
Don’t Forget
your medication - Nefidepine
check when it expires
keep your alert card with you.
Paracetamol for ongoing headache
Radar key for access to Disabled Toilets