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Autonomic Dysreflexia

Posted: 02 Apr, 2017. No comments
image of a card with advice on treatment of autonomic dysreflexia

Since we are on Cyprus, and given the potential for sunburn to be a trigger cause of AD it seems prudent to post this information. There is a trove of further reading on the web and I particularly commend

Christopher & Dana Reeve Foundation,

UAMS, and

Wikipedia

from whom I have quoted.

Autonomic Dysreflexia is a life threatening condition which can affect people with a spinal cord injury.  Being able to spot the signs and symptoms of AD is important. As is the quick, correct application of the appropriate treatment.

It’s important for at-risk individuals to know their baseline blood pressure values and to communicate to healthcare providers how to identify as well as manage an AD emergency.

Causes of AD
AD is caused by an irritant below the level of injury, including:

Bladder: irritation of the bladder wall, urinary tract infection, blocked catheter or overfilled collection bag.
Bowel: distended or irritated bowel, constipation or impaction, hemorrhoids or anal infections.
Other causes include skin infection or irritation, cuts, bruises, abrasions or pressure sores (decubitus ulcers), ingrown toenails, burns (including sunburn and burns from hot water) and tight or restrictive clothing.
AD can also be triggered by sexual activity, menstrual cramps, labor and delivery, ovarian cysts, abdominal conditions (gastric ulcer, colitis, peritonitis) or bone fractures

Autonomic dysreflexia (AD),  is a potentially life-threatening condition which can be considered a medical emergency requiring immediate attention. AD occurs most often in individuals with spinal cord injuries with spinal lesions above the T6 spinal cord level.

Signs and symptoms
This condition is distinct and usually episodic, with the people experiencing remarkably high blood pressure (often with systolic readings over 200 mm. Hg), intense headaches, profuse sweating, facial erythema, goosebumps, nasal stuffiness, a “feeling of doom” or apprehension, and blurred vision. An elevation of 40 mm Hg over baseline systolic should be suspicious for dysreflexia.

Initial Treatment

Often, sitting the patient up and dangling legs over the bedside can reduce blood pressures below dangerous levels and provide partial symptom relief. Where this is not practical or safe, consider using the Theraposture or Baltic bed to lower the legs and elevate the upper body.

Tight clothing and stockings should be removed. Seek qualified medical advice.

Proper treatment of autonomic dysreflexia involves administration of anti-hypertensives along with immediate determination and removal of the triggering stimuli.

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