Spinal Cord Injury (Autonomic Dysreflexia)

  1. What is autonomic dysreflexia?
    • over activity of autonomic nervous sys
    • massive imbalance in reflex of sympathetic discharge
    • unique to spinal cord T5-T6
    • is an emergency
  2. Pathophysiology of AD?
    • SCI pts are normally hypotensive, but with activation of AD (irritating/painful stimulus below the level of injury)-->
    • nerve impulses block by SCI. 
    • peripheral artery hypertension due to sympathetic surge causing vasoconstriction.
    • Impulses cannot reach brain, 
    •  Baroreceptors slow hb, blood vessels dilate above level of injury
    • No messages are received below the level of injury, therefore the blood pressure cannot be regulated
  3. Epidemiology of AD
    • After spinal shock
    • more common if injury traumatic
    • Less likely as injury heals (old injuries), but if does manifest may have unusually symptoms. 
    • Younger age groups report less incidences
    • mostly male phenomenon because men are stupid. 
    • Rare, but can happen as low as T10 (usually pregnant women)
  4. SnSs of AD
    • pounding headache
    • nasal congestion
    • red blotches of the skin above level of SCI
    • Brady card
    • Hypertension--> ^ 20-40mmHg over baseline (adult), 12-20 adolescent
    • Goose pumps below SCI.
    • Sweating above
    • Flushed red face
    • Restlessness
    • nausea
    • cold, clammy skin below SCI.
  5. Causes of AD after spinal cord injury
    • Painful, noxious stimuli below level of injury, usually bladder
    • bowel, ie gall stones
    • Skin
    • Sexual activity
    • Others, i.e. skeletal fractures or internal organ issues.
  6. Complications associated with AD?
    • Seizures (gran Mal)
    • MI
    • Cerebral hemorrhage
    • retinal hemorrhage
    • Cardiac arrest
    • death
    • If pt had an AD card, LOOK AT IT!!!
  7. Tx for AD?
    • must be initiated quickly to prevent complications
    • 1) Check BP and elevate head if necessary
    • 2) loosen constrictive clothing
    • 3) Work to identify the source of stimulus (bladder?)
  8. Medication Tx for AD?
    • Check for use of Viagra, Levitra, or Cialis in last 48 hrs. 
    • Nitrobid. Has short half-life so can be taken off quickly. 
    • Nitroglycerin, spray has short half life (1-4 mins)
    • May use Procardia (has long half-life, difficult to reverse), Clonidine (causes confusion), Hydrazine as last resort.
  9. Big take away points of AD?
    • Pts have good education on AD, so listen to them.
    • Focus on eliminating the cause/treating BP because...
Card Set
Spinal Cord Injury (Autonomic Dysreflexia)
Adult Med Surg 2