M15 - Autonomic Dysreflexia

Question 1

Autonomic dysreflexia, also known as “____”, is a medical emergency that may occur in patients with ___-____ ___ ____ ____ usually at __ level or above. The condition occurs as a result of a massive, uncompensated ____ reaction of the _____ Nervous system triggered by an ____ ____ ____ the level of injury.

Answer 1

Hyper reflex is
Pre-existing spinal cord injury
T6
Cardiovascular
Sympathetic
Irritating stimulus below

Question 2

Autonomic dysreflexia may present with (6)

Answer 2

• Sudden HT
• Pounding headache
• Bradycardia (reflexive to HT)
• Sweating and flushing above the level of injury
• Skin pallor and piloerection below level of injury
• SOB and associated anxiety

Question 3

Treatment of Autonomic Dysreflexia:

1. Patient care
   
   • Posture the patient _______
   • Loosen ___ ____ (e.g. compression stocking, abdominal binder)
   • Monitor ___ ____ closely (every - minutes)
2. Look for and rectify _____ _____ (often related to the ____ ____)
   
   • Is the ____ ____? Check the ______ tube is not kinked or blocked or the bag over-full. (Avoid pressing on the _____)
   • If the bag is over-full, empty _____.
3. Administer medication/s if indicated:
   
   • _______ (___)
4. ____ Transport for all patients with ____ ___, signs of ____, and persistent _____ despite treatment.
5. Regularly repeat and document ABCD physical examinations and physiological observations in order to identify trends in clinical deterioration.

Answer 3

Sitting with legs dependent
Tight clothing
Blood pressure
Reversible causes; urinary system
Catheter draining; catheter; bladder
Slowly
Glyceryl Trinitrate (209)
Urgent; altered LOC; stroke; hypertension

Question 4

Medication (1) for Autonomic Dysreflexia and caution note

Answer 4

Glyceryl Trinitrate (209)
- if SBP >= 20mmHg above resting level (is known) or >= 170mmHg
>=16yo

300mcg SL, repeat every 5 minutes whilst indicated (monitor BP closely), max dose 900mcg (1.5 tablets)

The use of medications for erectile dysfunction is common in patients with SCI. Do not use GTN due to the risk of profound hypotension in these patients.