Paralysis Resource Guide - (Page 61) HEALTH MANAGEMENT Secondary Conditions AUTONOMIC DYSREFLEXIA Autonomic dysreflexia (AD) is a potentially life-threatening medical emergency that affects people with spinal cord injuries at the T5 level or higher. Autonomic dysreflexia requires quick and correct action. Serious AD can lead to stroke. Because many health professionals are not familiar with this condition, it is important for people who are at risk for AD, including the people close to them, to know all about it. What to do: If AD is suspected, the first thing to do is sit up or raise your head to 90 degrees. If you can lower your legs, do so. Next, loosen or remove anything tight. Most importantly, locate and remove the offending stimulus, if possible. The signs of AD include high blood pressure (greater than 200/100), pounding headache, flushed face, sweating above the level of injury, goose flesh below the level of injury, nasal stuffiness, nausea and a slow pulse (slower than 60 beats per minute). Autonomic dysreflexia is caused by an irritant below the level of injury, usually related to bladder or bowel function. Among the causes are an irritation of the bladder wall, urinary tract infection, blocked catheter or overfilled collection bag, over-distended or irritated bowel, constipation or impaction, hemorrhoids or anal infections, skin infection or irritation, cuts, bruises, abrasions or pressure sores (decubitus ulcers), ingrown toenails, burns (including sunburn and burns from hot water) and tight or restrictive clothing. Autonomic dysreflexia can also be triggered by sexual activity, menstrual cramps, labor and delivery, abdominal conditions (gastric ulcer, colitis, peritonitis) or bone fractures. What happens during an episode of AD? Autonomic dysreflexia means an over-activity of the autonomic nervous system — the part of the system that controls things you don’t have to think about, such as heart rate, breathing and digestion. A stimulus below the injury level sends nerve impulses to the spinal cord, and they travel upward until they are blocked at the level of injury. Since the impulses cannot reach the brain, a reflex is activated that increases activity of the sympathetic portion of the autonomic nervous system. This results in spasms and a narrowing of the 61
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