Autonomic Dysreflexia - Duke of Cornwall Spinal Treatment
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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
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
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
Increased blood pressure
Bradycardia
Profuse sweating
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
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
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.
Pounding headache
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