autonomic dysreflexia

[crash]

Had a pt the other night...was a quadriplegic secondary to a spinal cord injury 5 years prior w/sudden onset of tachycardia, profuse sweating from the collarbones up, increased spasticity(especially in his hands), and fever. BP was 160/130, HR 160, no chest pain or palpitations, no shortness of breath--but feeling very ill and in acute distress--hx of uti diagnosis one week prior---turns out all he needed was his foley changed and all symptoms resolved. Seems like I read about this in JEMS not too long ago and it is a syndrome in spinal cord injury patients only and is usually but not always caused by an over-distended bladder and can be life threatening due to extraordingary BP leaps. Has anyone else ran into this in the field?

 

[Alpha752]

Wow. Never would have thought of that.

Guess Ive got some more studing to do.

 

[croaker260]

Actually, I wrote an article for EMS village on it back in 2000, and our service actually has a protocol for it, having encountered it in serveral repeat patients, that I developed with them. Our incidence is about 1/month.
There was also an article in JEMSA or EMS mag in the last year on it.

The link for my article is here, I am inthe process fo updating it as well.

http://www.emsvillage.com/village_library/...icle.cfm?id=114

 

[TheGodfather]

im aware that this thread is almost as old as i am, BUT:

Can anybody explain the pathology of AD with regards specifically toward prolonged distension of the bladder only (and no neurological deficit)... How and why exactly does this occur?

(that link is broken)

Thank you all!

 

[Trevor]

Perhaps Croaker can give a more accurate response, but this is how I understand it... (theres also a pretty decent, short article about it on eMedicine)

Basically, a sensory nerve impulse is carried to the brain via the spinal cord. Normally, an inhibitory impulse can decend through the spinal cord and help "counteract" a sympathetic response. In a healthy person, we can also relieve whatever (usually painful) stimulus is causing it. However, in a Spinal Cord Injury (SCI) the impulse does not make it through, so the Sympathetic response essentially goes unchecked, causing peripheral vasoconstriction, sweating, and other stimulation, below the level of the injury. The Baro-receptors around the heart can still pick up on this Hypertension, and sends the info back to the brain. The brain then attempts to recify it 2 different ways. 1) through inhibitory responses (decending) through the spinal column (which doesnt work, due to lack of communication between the CNS above and below the injury site. And 2) initiating the Vagus response to slow the heart rate, which usually isnt enough to conteract the sympathetic HTN response.
Once the stimulus is resolved the response usually subsides...

http://emedicine.medscape.com/article/322809-overview

 

[TheGodfather]

thank you trevor! I understand with spinal cord injury why this all happens (to some degree), but what has me stumped is this:

I did some reading and in the text it states this;

"autonomic hyperreflexia [or autonomic dysreflexia] is a serious complication of a prolonged distended bladder that causes hypertension, bradycardia, and increased ICP. "

This talks nothing about spinal cord injury, all it states is that the bladder is distended for a prolonged period of time... I know that being distended for a lengthy period will be painful, and impulses of pain will travel through the cord (and from my current understanding) -- the intact spinal cord will normally tolerate this response by sending a single autonomic trigger (norEPI, dopamine-b-hydroxylase, dopamine), whereas in spinal shock/transsection, instead of a single autonomic trigger, it fires rapidly and out of control........

is this a misprint in the book, or can it be seen with ONLY a distended bladder as it says --- and if it can, why?


thanks again everyone! sorry for the confusion!

 

[NomadicMedic]

I had a patient with Autonomic Dysreflexia. Luckily, he was able to tell me what was going on. It turned out he had an obstructed urinary cath and needed transported to clear it. (He lived at home, alone, and wasn't able to do his own cath care)

IIRC, his pressure was through the roof and he was FREAKING OUT! I wound up calling for orders for 1" of NTG paste and a SL NTG. Worked like a champ.

 

[Medic Tim]

where I work there is a guy who ends up calling once a month or so because his cath gets blocked. One of the times as we were moving him onto the stretcher it let go and he filled the bag in like 30 seconds. the distress went away almost instantly.

 

[jwk]

We put quadriplegic patients to sleep for surgery for this very reason.

 

[mycrofft]

And the obverse: drain too much from a distend bladder at once and....