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Autonomic Dysreflexia Anne Seaman Lead Nurse Duke of Cornwall Spinal Treatment Centre.

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Presentation on theme: "Autonomic Dysreflexia Anne Seaman Lead Nurse Duke of Cornwall Spinal Treatment Centre."— Presentation transcript:

1 Autonomic Dysreflexia Anne Seaman Lead Nurse Duke of Cornwall Spinal Treatment Centre

2 What is Autonomic Dysreflexia? Can occur quickly Is a life threatening medical emergency

3 Dysreflexia zFirst described in 1917, zIt is a protective mechanism that tells the person that something is wrong zImportant to view it as a positive warning sign zAlso known as autonomic hyperreflexia,

4 Who is at risk? zOccurs in 83-85% of tetraplegic and high level paraplegic persons injured (T6 and above) zIf is going to occur, it usually begins within the first few months following spinal shock

5 What happens zSCI results in the nerve pathways to the brain are interrupted. zWhen there is pain or discomfort below the level of your SCI it triggers a nervous system reflex response zThis begins a rapid increase in your blood pressure zThis will continue until the cause is found and treated

6 Possible Consequences of AD zRetinal haemorrhage in the eye zApnoea - breath holding zStroke zRenal (Kidney) failure zSubarachnoid (Brain) haemorrhage zSeizures (Fits) zCardiac dysrhythmias (Heart changes) zCardiac arrest zDeath All are rare

7 Prevention of AD zGood personal care zCareful bladder and bowel management zGood education zExpert Patient - in control

8 Most Common Causes? Research shows that the most common causes are: 1over distended bladder 2over distended bowel (Ceron & Rakowski-Reinhardt 1991, Dunn 1991, Finocchiaro & Herzfeld 1990, McGuire & Kumar 1986 cited Adsit & Bishop 1995)

9 Most Common Triggers zDistended bladder zDistended bowel zSkin breakdown zUTI zOther causes of pain or discomfort

10 Other Possible Triggers zIngrown toenails zExternal temperature extremes zClothing or shoes too tight zDigital stimulation of the bowel zBladder spasm and stones zSpasticity zSphincter bladder dyssynergia zAppendicitis zOrgasm z Burns and Sunburn z SIC z Enemas z Fractures z Ovarian cyst z DVT & PE z Perforated gastric ulcer z Heterotrophic Ossification z Orthastic hypotension z Oesophageal reflux

11 Response to Raised BP zThe body does try to reduce the BP, zonly able to do so above the level of injury, zwhich produces the well recognised symptoms of autonomic dysreflexia

12 Signs and Symptoms zHeadache - sudden & thumping zFlushed face – vasodilitation zBlotching of the skin – erythema zGoose bumps below the level of the lesion zPallor below the level of the lesion zIncreased blood pressure zBradycardia zProfuse sweating zNasal stuffiness zFear

13 Patient Specific Symptoms Some patients may not experience the common symptoms, particularly the thumping headache May complain of a ‘tight chest’ instead

14 Other Signs and Symptoms zIncreased spasm and spasticity zNausea zRespiratory difficulties zHeart beat changes zImpending sense of doom zVision changes zMetallic taste in the mouth

15 Treatment Are you at risk of AD? zLevel of SCI ? T6 or above zExtent of SCI ?complete/?incomplete zPrevious episodes zUsual cause zPost SCI new normal BP

16 Treatment zCarers or you need to act quickly & calmly, zEnlist help if needed zSit upright if in bed (helps to lower BP) zBP monitored every 3-5 mins in hospital zLoosen tight clothing & binders zAssess for cause – bladder & bowel first zPrepare for catheter change or bowel care

17 Find Cause: Bladder zCheck urine in drainage bag yFull, empty and monitor yEmpty, ?when last emptied zCheck for kinks in tubing zCheck for signs if catheter is dislodged zAny sign of haematurea? zCatheter blocked? Change it

18 Find Cause: Bowel zLast bowel care, ? Result – good/small zLie on left side (head raised) zPR check zIf full will need manual evacuation zLocal anaesthetic gel (3 mins) zGentle Manual Evacuation (ME) zLet AD resolve and then perform usual bowel care

19 Other Cause? z?Ingrown toe nail z?Pressure ulcer zGive analgesia z? Give Nifedipine zCall GP, will need treatment and possibly Nifedipine SR

20 Treatment zAdminister yNifedipine 5mg crush and swallow yOr GTN 300Micrograms/nasal spray (Only if diastolic BP is greater than 100mmHg) Patient should have a supply zIf this is unsuccessful and cause is not found inform a Dr/GP/go to ED as Phentolamine 5-10mg IV may be required zTime will be running out


22 Patient Information zAlert card zCarry medication zCare manual

23 Rehabilitation Process zAssessment zEducation xPatient, Family, Friends, Carers, xLesson Plan xSkills development xSkills assessment xIndependence xTeaching others

24 Rehabilitation Process zDeveloping skills xRecognition xSelf assessment – find cause xWhen to take medication xChange catheter xBowel care xSkin inspection zMonitoring xCare plan xDiary

25 AD Diary zThis diary is intended for you to use and keep as a record of your episodes autonomic dysreflexia. The intention is not for you to keep records indefinitely, but until you feel confident in your ability to recognise your symptoms together with any trends in the causes to help you to prevent further episodes. zName: zLevel of SCI …………………. Complete Incomplete Date of SCI …………… zNormal BP…………/…………….

26 Date of Autonomic Dysreflexia episode ……………………….. Symptoms: Put an ‘X’ in the box of all the symptoms you experienced.  Pounding headache  Heavy sweating  Blurred vision  Tight chest  Blotchy/flushed skin above SCI  Goose bumps  Anxiety/fear  Difficulty breathing  Other:

27 zCause: Comments:…………………………..………………….. zDid you need medication? Yes No zWhat did you take? ………... Dose(s) ………………. zDid you have any difficulties managing the episode?  Yes  No zComments: …………………….………………………..

28 AD Kit It is advisable to carry suitable equipment zgoing out zon holiday If you out and unable to find a suitable place to manage an episode of AD call 999 for help. In your local area HAVE A PLAN.

29 Catheter Supplies zHand wipes or gel zSyringe to remove catheter if using an indwelling catheter zSpare catheter correct size zBladder syringe zInsertion supplies including hand wipes and gloves zSterile syringe to put water into the balloon, sterile water zDisposal bag zSpare clothing if you usually bipass the catheter/leak

30 Bowel Care Supplies zLatex gloves zPolyethylene gloves zAnaesthetic lubricating gel zWet wipes (baby wipes), tissues zDisposal bag zSpare clothing

31 Don’t Forget zyour medication - Nefidepine zcheck when it expires zkeep your alert card with you. zParacetamol for ongoing headache zRadar key for access to Disabled Toilets

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