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:_________________
_______________________________
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: _____________________
________________________________
More information:
PRM department: ___________________
_________________________________
_
Related
sites:http://emedicine.medscape.com/article
/322809-overview
http://sci.washington.edu/info/forums/report
s/autonomic_dysreflexia.asp#report
Medical information has been endorsed
of …….., 2016
by the ………… SocietyLogo
PRM,
National PRM
Society
By the SIG for SCI of ESPRM, , 2016
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: ______________
…………….. SOCIETY OF PRM
In accordance with international
2016
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
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
•
•
•
•
•
sit patient upright (not lying
down)
Monitor blood pressure (BP)
every 3-5 min
Remove whatever is tight
below the level of the lesion
(clothing, etc.)
quick exam to include
abdomen
for
distended
bladder or bowel, lower limbs
for skin lesion, fractures, e.t.c.
in order to reveal the stimulus
that caused AD and treat it
If indwelling urinary catheter is
in
place,
check
for
obstructions
•
•
•
•
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
(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