Autonomic Dysreflexia

Question 1

Do patients who suffer an Autonomic Dysreflexic episode require Tx?

Answer 1

Yes

Question 2

Where does the patient have to have a cord injury to confirm that it could be AD?

Answer 2

T6 and Above

Question 3

Confirmation that a patient is suffering from AD have ______ and/or ____

Answer 3

Severe Headache and/or SBP>160mmHg

Question 4

What are some possible causes of AD?

Answer 4

Kinked in-dwelling catheter; Pain; physical trauma

Question 5

If Rx of possible causes in AD have nil effect what is the next line of treatment? (Doses)

Answer 5

GTN 300mcg S/L OR 600mcg S/L (if had before)

Question 6

If inadequate response to GTN in AD, what is the next step?

Answer 6

Repeat Initial dose after 10/60

Question 7

When should GTN stop being repeated in AD

Answer 7

• Symptom Resolve
• Onset of side effects
• BP < 160mmHg

Question 8

Where should pt’s with AD be transported to?

Answer 8

Nearest Hospital

Question 9

What is the pathophysiology of AD?

Answer 9

1. Insult, trauma, stimulus below T6
2. Initiates sympathetic response
3. Causes vascoconstriction which leads to hypertension
4. Carotid arteries notice hypertension
5. Brain is stimulated to try and reduced hypertension
6. Brain dilates blood vessels above T6 as message unable to get past T6
7. Leads to facial flushing and headache
8. Vagus nerve (Cranial Nerve 10)responds by slowing the heart rate down
9. Prolonged episodes can lead to Hypertensive Encephalopathy
10. Coma
11. Death

Question 10

How does GTN work in AD?

Answer 10

• Causes systemic Vasodilation to try and reduce blood pressure