Autonomic Dysreflexia

Question 1

Autonomic dysreflexia

Answer 1

Autonomic dysreflexia is an abnormal, overreaction of the involuntary (autonomic) nervous system to stimulation following a spinal cord injury above T5-6. This reaction may include: Change in heart rate. Excessive sweating. High blood pressure

Question 2

Autonomic dysreflexia pathophysiology

Answer 2

• SCI above T5-6 which is life-threatening as a result of overactivity of the ANS, specifically the PNS.
• Occurs when a stimulus (i.ie. blocked catheter, full bowel, injury, pain (labour, fracture) occurs below the level of SCI.
• The stimulus sends nerve impulses to the signal cord, where they travel upwards until blocked at level of injury.
• Since does not reach the CNS, a reflex response is activated that increases the activity of the SNS.
• This results in vasoconstriction = increased BP below the level of injury.
• HTN and vasoconstriction is sensed by baroreceptors within the aortic arch, causing the brain to attempt to intervene, resulting in vasodilation above the level of injury.
• If these unopposed autonomic systems continue to increase, can cause cerebral haemorrhage, seizures and death.

Question 3

Autonomic dysreflexia signs & symptoms

Answer 3

Injury above T5/6
Severe headache
BP >160mmHg
Flushing below injury
Coole, pale above injury

Question 4

Autonomic dysreflexia Causes

Answer 4

· Bladder distension.
· Urinary tract infection.
· Bowel distension.
· Bowel impaction.
· Gallstones/Gastric ulcers or gastritis.
· Haemorrhoids.
· appendicitis or other abdominal pathology trauma.
· Menstruation.
· Deep vein thrombosis/Pulmonary emboli.
· Pressure ulcers.
· Ingrown toenail.
· Burns or sunburn/Blisters.
· Insect bites.
· Contact with hard or sharp objects.
· Pain
Barotrauma

Question 5

Autonomic dysreflexia management

Answer 5

• Identify and remove stimulus: IDC, analgesia
• Administer GTN Subling until symptoms resolve or BP <160mmHg
  Can repeast at 10mins if symptoms continued or BP >160mmHg