WORKING TOWARDS
EUROPEAN / INTERNATIONAL
MEDICAL EMERGENCY
AUTONOMIC DYSREFLEXIA CARD
(You are kindly asked to make your comments on this word
document and send it back to:
C-A.Rapidi: rapidicha@hotmail.com)
During the initial rehabilitation process autonomic dysreflexia (AD) is
inadequately emphasized by the Rehabilitation team (usually AD is a problem
in more chronic phase). Patients with SCI and their caregivers are coping with
the tremendous changes in their quality of life post injury; and have poor
recognition of the symptoms and understanding of the causes of AD. (Table 1:
Knowledge of AD among patients / their caregivers / health personnel)
Table 1:
Knowledge of AD among patients / their caregivers / health personnel
Author / year / country /
Total Sample Size
CF McGillivray, et al.
JSCM, 2009
Canada
N=100 chronic SCI, 16
family members
Method / Aim
Results
self-report mail survey to:
(a) evaluate knowledge of AD among SCI
consumers and their family members and
(b) to identify the preferred format and timing of
education on AD for these stakeholders.
high-risk group for AD,
41% of the sample had
never heard of the
condition
J Schottler, et al.
Spinal Cord, 2009
USA
N=215 (1-21 years old)
The incidence of knowledge of AD from patient
and caregiver perspectives
40% of patients & 44% of
caregivers
claimed
symptoms of AD, and out
of them:
15% of patients & 9% of
caregivers did not know
the definition of AD or did
not recognize the term
AD when first asked
CR Jackson, R Acland
Emerg Med J, 2011
New Zealand
N=70 (18 doctors, 52
nurses)
A questionnaire was designed to assess the
knowledge of the ED staff on AD
41% of the staff in
emergency department
could not answer any
questions
There is a need to improve knowledge and management of AD among
healthcare professionals not specialized in SCI, ED personnel, Primary care,
patients and caregivers
A series of strategies may contribute to improve knowledge and
management of AD:
• Campaign in general hospitals without experience in SCI
rehabilitation
• Information in triage folders
• Educational courses on AD among healthcare professionals
• Leaflets with medical information concerning AD in emergency
rooms and GPs’ offices
• Education of patients, their families and care givers
• Web sites where health professionals and consumers can obtain
information from one another.
• Carrying an AD card
AUTONOMIC DYSREFLEXIA EMERGENCY CARD
Autonomic dysreflexia cards have been developed by different countries,
organizations, in different sizes, with different information, focusing in different
target groups.
The different providers of cards are (Information by internet surfing):
• Patients’ Associations & non-profit charity Foundations (the
majority)
• SCI Hospitals & Rehabilitation Centers
• SCI Scientific Societies
There are many different things to consider on the medical emergency AD card
practical issues:
size, letters’ size: satisfactory or small, squashed text, text easy to read or
not
text quality:
concisely written text (what AD is, symptoms, signs, causes), clear
recommendations for health providers,1st line drug, clear recommendations for
patients & caregivers
personal information:
Name, contact details, Rehabilitation Department/Hospital or other center,
responsible for the patient and his medical file, Neurological Level of Injury, AIS,
previous AD episodes
who is responsible for the AD card creation AND when it is updated:
clearly written: who is scientifically responsible for what is written on the
card, card provider’s contact details for more information
who is responsible for the distribution of this AD card
A universal AD card should be suggested by the SIG for SCI of ESPRM in
English language and should be translated to national languages too. Patients
could curry in their wallets both versions. This card with a universal figure and
same colors would be easily recognized all over the world.
This card:
•
•
•
•
•
Should have a convenient shape, like a wallet card, to be easily carried
Should have some individualized information
Should be official and endorsed by scientific societies
Should be regularly updated
It may be distributed by the PRM Department/Hospital/Center, primary
healthcare provider
A working hypothesis
for a European emergency medical AD card
(you san print this card from
the attached pptx “AD CARD, 2016 eng”)
Dimensions: 5.3/8.5 folded = wallet size
8 pages
1st page: definition of AD (very briefly)
personal ID
Neurological Level of Injury (NLI)
Basal Blood Pressure (BP basal)
Allergies
Rehabilitation Department
tel. of relatives
2nd page: definition of AD
3rd page: common signs & symptoms, common causes
4th & 5th page: what to do (physicians)
6th page: awareness for “physiologic” BP of SCIed patients, previous AD
episodes details
7th page: previous AD episodes details, notes
8th page: for more information contact Rehabilitation department & the
following links
Medical information is endorsed by:
National PRM Society (HSPRM-SCIS & University of Patras SCI Reha
Department)
ESPRM (SIG for SCI)
Comments: wallet size, clear recommendations, 1st line drug: NIFEDIPINE
1st Page
MEDICAL EMERGENCY CARD
for AUTONOMIC DYSREFLEXIA
(sadden hypertensive crisis)
Patient with spinal cord injury
above T6 neurotome level
Name: __________________________
Neurological level of Injury ( ISCoS / ASIA):
________________________
Basic BP: ______________mmHg
Allergies: ______________________
Rehabilitation Department: ________
________________________________
Tel:____________________________
Tel of relative: ______________
8th Last page
More information:
PRM department: ___________________
__________________________________
Related sites:
http://emedicine.medscape.com/article/322809-overview
http://sci.washington.edu/info/forums/reports/autonomic_dysreflexia.as
p#report
Medical information has been endorsed:
by the National Society PRM,
by the ESPRM (SIG for SCI)
In accordance with international guidelines
2nd Page
AUTONOMIC DYSREFLEXIA (AD)
Patient with tetraplegia or high paraplegia (SCI above T6) may present a
sudden dysfunction of autonomic nervous system resulting from stimulus
below neurological level of injury, this dysfunction is called: AD
AD is an unopposed overactivity of sympathetic nervous system, leading to a
sudden increase of blood pressure. If AD is not treated in time may lead to
intracranial haemorrhage, stroke, seizures or even death
3rd Page
COMMON SYMPTOMS & SIGNS
feeling of great anxiety
high BP, sudden rapid increase
pounding headache
flushing & sweating above the level of injury
paling, vasoconstriction below the level of injury (sweating sometimes)
slow or rapid heart rate
breathing difficulty
blurring of vision
stuffy nose
Nausea
COMMON CAUSES
urine retention
plugged catheter
fecal impaction
pressure sore or burn
ingrown toenail
fractures of lower limbs
UTI
any noxious stimulus below the level of injury
4th Page (Treatment)
•
•
•
•
Sit patient upright (not lying down)
Monitor blood pressure every 3-5 min
Remove whatever is tight below the level of the lesion (clothing, etc.)
Quick physical exam to include abdomen for distended bladder or bowel,
lower limbs for skin lesion, fractures, etc. in order to reveal the stimulus that
caused AD and treat it
• If indwelling urinary catheter is in place, check for obstructions
5th Page (Treatment)
• If an indwelling catheter is not in place, catheterize the patient using
anesthetic jelly
• ATTENTION: If there is a need to check bowel, this must be done using
anesthetic jelly
• If BP despite previous management is high (>150mmHg), give an
antihypertensive with rapid onset and short duration anti-hypertensive drugs
(e.g.sublingual nifedipine), may repeat in 20-30min, and continue investigate
causes of AD
• If IV antihypertensives are needed, this should be done only in a monitoring
setting of ICU
6th Page
ATTENTION!
The “normal” baseline BP of persons with high SCI is usually 90/60mmHg
in supine position and even lower in sitting position. An increase
>20mmHg above baseline BP is an AD episode, and if this not treated
immediately, may lead to extremely increased BP (240/130mmHg)
History of AD episodes:
Frequency:______________________
Usual cause:_____________________
BP up to __________mmHg
Symptoms:______________________
Usual treatment:__________________
_______________________________
7th Page
History of AD episodes:
Frequency:_________________________
Usual cause:_______________________
BP up to __________mmHg
Symptoms:_________________________
Usual treatment:____________________
__________________________________
History of AD episodes:
Frequency:_________________________
Usual cause:_______________________
BP up to __________mmHg
Symptoms:_________________________
Usual treatment:____________________
__________________________________
Notes: _____________________________
_____________________________________
(You are kindly asked to make your comments on this word
document
and send it back to: C-A.Rapidi:
rapidicha@hotmail.com)
Thank you in advance for your contribution in this effort: “working towards a
medical emergency AD card”.
Christina-Anastasia RAPIDI
President of the Hellenic Spinal Cord section of PRM