Adult Autonomic Dysreflexia

Question 1

Why must pt be transported even with resolved symptoms

Answer 1

For F/I of cause of event - if left untreated can cause cerebrovascular catastrophe

Question 2

Confirming autonomic dysreflexia

Answer 2

Injury to T6 or above
Severe headache +/-
SBP >160mmHg

Question 3

Potential stimuli to recognise and mgx

Answer 3

Kinked catheter
pain (#, dislocation, burns)
Labour

Question 4

Tx for autonomic dysreflexia

Answer 4

GTN 600mg (300 if elderly/frail/first time)
repeated 10/60 until resolution of symptoms, C/I or SBP <160mmHg
T/F to hospital

Question 5

GTN Indications

Answer 5

Chest pain in acute coronary syndrome
Hypertension associated with acute coronary syndrome
Acute cardiogenic pulmonary oedema
Autonomic dysreflexia
Preterm labour (consult for GTN patch)

Question 6

GTN COntras

Answer 6

BP < 100 mmHg
HR > 150 bpm
HR < 50 bpm (except in autonomic dysreflexia)
Ventricular tachycardia
PDE5 inhibitors (current/recent use)
Riociguat (current use)

Question 7

GTN Precautions

Answer 7

Use lower doses (i.e. 300 mcg) in patients who are elderly (age > 60), have no previous
exposure to GTN, or with recent MI, as they may be more susceptible to adverse effects

Right ventricular MI or inferior STEMI with systolic BP < 160 mmHg - use cautiously due to risk
of severe hypotension from preload reduction

Preterm labour - concurrent use with other tocolytics

Question 8

GTN Side Effects

Answer 8

CV: hypotension, tachycardia, bradycardia (occasionally)
CNS: headache, dizziness, syncope
Other: skin flushing