Jerry Haney, SCI Series, AD Card

I sincerely hope the information presented will be useful and help you and yours cope with this devastating injury.

If you do not find a subject shown here, please let me know and I will certainly try to research the information and present it on this website in continuing updates.

This important section is devoted to the medical and medication information needed by the SCI, drugs and what they do, side effects, your prescription, autonomic dysreflexia, causes, symptoms, what to do, how to prevent this condition from occurring.

MEDICAL ALERT FOR AUTONOMIC DYSREFLEXIA ________________________________ is subject to the above syndrome. This is a serious medical problem that can occur in people with a spinal cord injury at or above the 6th thoracic level. The symptoms of autonomic dysreflexia (AD) can be caused by many types of stimuli below the level of the spinal cord injury, but the most common emergency causes are: 1) full or spastic bladder or 2) bowel distention (usually from stool in the rectum). Severe AD is a medical emergency which if not properly treated can result in cerebral vascular hemorrhage (stroke).

Symptoms:

1. Pounding headache.

2. Flushing of skin and sweating above the level of injury.

3. Increased blood pressure (as high as 250/150), slow pulse.

4. Apprehension / anxiety.

5. Nasal stuffiness.

6. Vision changes, blurring, spots before the eyes.

7."Goose bumps."

Medical Treatment:

1. If the AD episode is not resolving after the above measures, medical treatment is necessary. Ask the patient if he has his own supply of any of the AD medications. If not, transport patient to an emergency room as soon as possible.

2. If the AD episode is not resolving and / or the blood pressure reaches 160 systolic, give the patient Nifedipine 10mg sublingual. Instruct patient to bite through the capsule and hold it beneath his tongue. May repeat Nifedipine dosage after 15 minutes if blood pressure has not responded.

3. Continue to look for causes of AD by checking the patient's entire body. Other causes includes fractures, sores and tight clothing.

4. Alternative treatments (if Nifedipine not available or does not work);

WHAT TO DO: (First Aid)

1. Place patient in a sitting position.

2. Drain the bladder.

a. if catheter in place, check for kinking. If catheter is plugged, do not try to irrigate. Change foley using Lidocaine jelly for lubrication.

b. If no catheter is present, insert a catheter using Lidocaine jelly for lubrication. Don not crede (push on) the bladder.

3. If emptying the bladder has not decreased the blood pressure and there is stool in the rectum, apply Lidocaine jelly to the anal sphincter and wait five minutes. Then, using a Lidocaine lubricated gloved finger, gently remove stool from the rectum.

a. Nitroglycerine ointment: 1 inch to upper chest or back. If no resolution in 15 minutes, add additional 1 inch.

b. Markedly elevated blood pressure not responding to the above measures should be treated with IV Apresoline (20mg/1cc). Inject .5c SLOWLY. May repeat dosage after 15 seconds if no response. Other IV medicines maybe substituted.

5. Blood pressure may be safely lowered to 90/60, which is typical of quadriplegics in the sitting position.

6. After an episode of AD, it is not uncommon for a second episode or rebound to occur, so blood pressure should be checked every 30 - 60 minutes for the next 4 - 5 hours.

7. Patient should be monitored for hypotension after treatment of AD.

REMEMBER. If you do develop autonomic dysreflexia, you will soon learn what causes it for you. It is then that you will be able to treat it quickly and effectively. CARRY A CARD! An example of a card you can cut out and carry in your wallet is provided above. Put your name in the space below "FOR AUTONOMIC DYSREFLEXIA" on the card. Let people know you have this card and use it with medical staff to instruct in emergency care. It may save your life! Always check with you Doctor or health care provider BEFORE treatment to verify what may be right for you.