Which of the following clients is at highest risk for autonomic dysreflexia?
Introduction[edit | edit source]Autonomic Dysreflexia (AD) is a common life-threatening condition after a Spinal Cord Injury (SCI), usually occurred if SCI is at or above the T6 level. AD is characterized by a sudden, exaggerated reflexive increase in blood pressure in response to a noxious stimulus, commonly bladder or bowel distension, arising below the neurological level of injury (NLI) [1]. Show
[2] Signs & Symptoms[edit | edit source]Acute autonomic dysreflexia is characterized by
Pathophysiology[edit | edit source]
Etiology[edit | edit source]The cause of this condition is a spinal cord injury, commonly at or above the T6 level. In the examination, an AD episode has described an increase in systolic blood pressure of at least 20-40 mm Hg or more above baseline[4]. A severe episode would usually have a systolic blood pressure of at least 150 mmHg or more than 40mmHg above the patient's baseline. The higher the injury level, the greater the severity of the cardiovascular dysfunction. The severity and frequency of autonomic dysreflexia episodes are also associated with the severity of the spinal cord injury as well as the level. Patients with a complete spinal cord injury are more than three times more likely to develop autonomic dysreflexia than those with incomplete injuries (91% to 27%)[6]. Autonomic dysreflexia does not develop until after the period of spinal shock when reflexes have recovered[4]. The earliest reported case appeared on the fourth-day post-injury. Most of the patients (92%) who will ultimately develop autonomic dysreflexia will do so within the first year after their injury. The six "B"s that are the common triggers of autonomic dysreflexia[1]:
Bladder distention is the most common cause for about 85% of all cases and is by far the most common trigger followed by fecal impaction[7]. Diagnosis[edit | edit source]The most common initial complaint is a severe throbbing headache. If the patient with spinal cord injury (spinal cord injury at or above the T6 level) complains of a severe headache, the practitioner should immediately have their blood pressure checked. If BP is elevated, a provisional diagnosis of autonomic dysreflexia can be made. The diagnosis can also be made by obtaining a history of previous autonomic dysreflexia episodes with the triggering event if known, monitoring vital signs, and watching for any developing signs and symptoms. Many patients with spinal cord injuries will have hypotension. Orthostatic hypotension is found in over 50% of patients with autonomic dysreflexia[8]. Fortunately, most episodes are relatively mild and can be managed at home by the patient and their usual caregivers without acute medical intervention[3]. Epidemiology[edit | edit source]Autonomic dysreflexia affects 48% to 70% of patients with a spinal cord injury above the T6 level and is not very common to affect if the injury is below T10 in patients with spinal cord injury[5]. Guillain–Barré Syndrome may also cause autonomic dysreflexia[9]. Physiotherapy Management[edit | edit source]In the event of an episode, the physiotherapist should perform the following steps:
Note: If the Clinician cannot find the triggering stimulus and above-mentioned steps do not manage the systolic blood pressure below 150 mmHg or less than 40 mmHg above the patient's usual baseline, the clinician should immediately inform the medical staff (doctor or nurse) . Complications[edit | edit source]Common complications of Autonomic Dysreflexia are:
Prognosis[edit | edit source]The prognosis of autonomic dysreflexia is good if the condition is identified early, and sufficient education is provided to the patient with spinal cord injury and caregivers. Differential Diagnosis[edit | edit source]
Resources[edit | edit source]An excellent free informational website devoted to patient and professional education about spinal cord injuries can be found at the International Spinal Cord Society (ISCoS) website e-learning modules. It provides educational modules designed for all stages and levels of spinal cord injury for both laypersons and healthcare personnel[4]. [11] References[edit | edit source]
Which patient is at most risk for developing autonomic dysreflexia?Autonomic dysreflexia is a condition that emerges after a spinal cord injury, usually when the damage has occurred above the T6 level. The higher the level of the spinal cord injury, the greater the risk, with up to 90% of patients with cervical spinal or high-thoracic spinal cord injury being susceptible.
Which of the following are risk factors for autonomic dysreflexia?Some of the things that can trigger AD are:. A full bladder (common) or a blockage in a catheter.. A bowel that is full of gas or stool.. Clothing that is too tight.. Wounds or pressure sores.. Skin infection or irritation.. Gallstones.. Burns.. Broken bones.. What is the most common cause of autonomic dysreflexia?The most common cause of autonomic dysreflexia (AD) is spinal cord injury. The nervous system of people with AD over-responds to the types of stimulation that do not bother healthy people.
What are the leading causes of autonomic dysreflexia in a SCI patient?Bladder distension or irritation is responsible for 75-85% of the cases. Bladder irritation is commonly caused by a blocked or kinked catheter or failure of a timely intermittent catheterization program. The second most common cause of autonomic dysreflexia is bowel distention, usually due to fecal impaction.
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