Daily Bolus of LR: Autonomic Dysreflexia

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October 13, 2011 by dailybolusoflr

Autonomic Dysreflexia

 

·         This condition typically is found in patients with spinal cord injuries above T6

·         Is manifest by sudden elevations in BP, diaphoresis, flushing, piloerection, bradycardia or dysrhythmias, anxiety, headache, nasal stuffiness and/or blurred vision

·         Patients may simply have elevations in BP and no symptoms

·         The most common cause of autonomic dysreflexia is bladder distention and as such, the first attempt to break this cycle is bladder catheterization and/or checking of the indwelling bladder drainage system

o   Note: catheterization or manipulation of the catheter can worsen the dysreflexia and lead to worsening elevations in BP.  Use of lidocaine jelly is thought to decrease sensory input and perhaps decrease the autonomic response.  It is not intuitive, as these patients are often insensate.

·         The second line of investigation if there is no urinary obstruction is to check for fecal impaction

o   If dis-impaction is to occur, instill lidocaine jelly before attempting

·         If medications have been given before decompression of the urinary system or dis-impaction, release of the inciting trigger may lead to hypotension

·         If patient require pharmacologic treatment (consensus panel states SBP over 150, as most high cord injured patients have SBP around 90-110), consider using drugs with rapid onset and short duration

o   Nifedipine and nitrates are the most commonly used agents

·         Most sources agree that if patients have been stable for 2 hours or more, they can be discharged provided the etiology of the autonomic dysreflexia is found

 

Ref:  Paralyzed Veterans of America/Consortium for Spinal Cord Medicine. Acute management of autonomic dysreflexia: individuals with spinal cord injury presenting to health-care facilities. Washington (DC): Paralyzed Veterans of America (PVA); 2001

http://www.guideline.gov/content.aspx?id=2964

 

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