Lecture on Autonomic Dysreflexia

Introduction

Autonomic Dysreflexia (AD): Also known as autonomic hyperreflexia.
Definition: An exaggerated reflex response by the autonomic nervous system, particularly the sympathetic nervous system (fight or flight).
Important to prevent, detect, and manage as it is a medical emergency.

Irritating stimulus below the site of spinal cord injury.
Highest Risk: Patients with T6 or higher spinal cord injuries.
Common Causes: Referred to as the three big B's:
- Bladder issues: Urinary tract infections, full distended bladder.
- Bowel problems: Impacted stool in the rectum.
- Breakdown of skin: Pressure injuries, cuts, infections, ingrown toenails.
Miscellaneous Causes: Menstruation, childbirth, sexual intercourse.

Autonomic Nervous System: Divided into sympathetic (fight or flight) and parasympathetic (rest and digest).
Sympathetic Response:
- Vasoconstriction, leading to high blood pressure.
- Increased heart rate, dilated pupils, bronchodilation, sweating.
Parasympathetic Response:
- Vasodilation, leading to lowered blood pressure.
- Decreased heart rate, bronchoconstriction, increased salivation, pupil constriction.
In AD, sympathetic response is unopposed due to impaired parasympathetic response from spinal cord injury.
Impact of Separation: Leads to excessive sympathetic response causing severe hypertension, potential stroke/seizures.

Headache: Often throbbing/pounding.
Hypertension: Systolic blood pressure 20-40 mmHg above baseline.
Skin Changes:
- Above site of injury: Flushed and warm.
- Below site of injury: Pale, cool, and clammy.
Bradycardia: Heart rate less than 60 BPM.
Other Symptoms: Sweating, goosebumps, dilated pupils, stuffy nose, anxiety.

Prevention, Detection, Action (PDA):
- Prevention:
  - Manage bladder issues: Ensure bladder is emptied, check urine output (>30 cc/hr), prevent UTIs.
  - Manage bowel issues: Monitor bowel sounds, check for impaction.
  - Manage skin integrity: Remove binding devices, reposition every 2 hours, assess skin.
- Detection:
  - Monitor blood pressure regularly, especially for patients with T6 or higher injuries.
  - Look for symptoms of AD (headache, skin changes).
- Action:
  - Call for rapid response in hospital.
  - Position patient at 90 degrees (legs lowered).
  - Remove binding devices or clothing.
  - Investigate and address causes: bladder, bowel, skin.
  - Use medications if necessary (e.g., nitropaste, nifedipine).