《外科急诊创伤(英文)-自主反射障碍》由会员分享，可在线阅读，更多相关《外科急诊创伤(英文)-自主反射障碍（9页珍藏版）》请在金锄头文库上搜索。
1、Autonomic Dysreflexia,Leaugeay Webre BS, CCEMT-P, NREMT-P,What is it?,An emergency condition that requires immediate attention! Is most likely to occur in a patient with a spinal cord injury at or above T-6 An abnormal response to a problem somewhere below the injury level and usually due to bowel o
2、r bladder problems,Scenario,You are in the middle of a routine transfer of a patient with a non acute SCI at T-6 You notice your patient is becoming flushed and diaphoretic He is complaining of a pounding headache Goosebumps appear above the injury site The patient is anxious and c/o tightness in hi
3、s chest You had just initiated a BP check which is 20 mmHg above the last one of 110 SBP,Fortunately for both you and your patient you had recently been inserviced on autonomic dysreflexia and you immediately suspect this life threatening condition,Common Causes,Overfull bladder or bowel Any binding
4、s below the site of injury Catheter taped to leg Pressure sores Contact with hard or sharp objects DVTs or PE Injuries Too tight clothing, appliances, shoes Extreme temperature changes,Pathophysiology,Something is wrong which causes the body to send messages to the spinal cord The spinal cord attemp
5、ts to send the message but the SCI blocks it The autonomic NS is activated which causes vasoconstriction in the legs and abdomen Extra blood is forced into the rest of the body causing an abrupt increase in systemic BP,Baroreceptors tell the brain that the BP is getting too high and it sends out imp
6、ulses to decrease the BP:slowing HRvasodilation in face, neck and upper chestattempts to dilate vessels below SCI but the message is blocked BP continues to rise resulting in stroke, cardiac arrest and death,Management,Immediately raise head to 90% and lower legs Loosen or remove any tight clothing
7、or appliances, tape etc. Empty catheter bags, assess for kinks Assess BP q 5 minutes Consider medications for BP control,Conclusion,You are able to appropriately manage your patient and divert back to the ER for reevaluation of your patient All the staff is excited to see you and brings you cookies and a soft drink Dispatch says you have messed up the transport rotation of non-emergent transfers Well, your patient likes you anyway.,
