Yes You Can - Fourth Edition - 63

Next, check for bowel problems. Check for stool. If there is stool in your rectum, remove it manually. Before removing the stool, you can apply a numbing medicine, such as lidocaine, to the anus and then wait a few minutes for it to work. This will prevent irritation to the area, which could cause your blood pressure to go up even more. Check for skin problems. If neither your bladder nor your bowel seems to be the cause, strip and look for cuts, bruises, or pressure ulcers on your body. 4. If the symptoms don’t go away or your blood pressure continues to be high [top number higher than 150], consider using a medication to temporarily lower it. Many health-care providers prescribe blood pressure medications you can keep on hand to treat AD, along with instructions on how to use them. The medicine will lower your blood pressure while you’re trying to ﬁnd out what is causing the AD. If you’ve been given nitroglycerin ointment, apply it to the skin above the level of your injury. 5. If you can’t ﬁnd the cause, get help. Notify your health-care provider immediately because this is a medical emergency. Call or go to the nearest hospital. Autonomic dysreﬂexia is an unusual problem, and not all health providers know how to treat it. Present your medical alert card for AD [SEE FIGURE 1.i.2] or ask the medical personnel to look up the treatment guidelines for AD published by the Consortium for Spinal Cord Medicine. These guidelines are available on the PVA website at www.pva.org/CPGs. [ Figure 1.i.2 ] Wallet Size Card for Autonomic Dysreﬂexia CUT ON SOLID LINES FOLD ON DOTTED LINES Autonomic Dysreflexia Treatment 1. 2. Raise the head of the bed up to 90 degrees or sit the person upright. Check for the source of the AD: full bladder or bowel, tight clothing, ingrown toenail, pressure ulcer, or any other noxious stimulus. Removing the cause will usually eliminate or decrease the symptoms. Monitor the blood pressure and pulse every 5 minutes. Drain or irrigate the bladder, using a topical anesthetic jelly for catheterization. Check the rectum for stool, after first applying an anesthetic ointment to the rectal wall. If stool is present, begin digital stimulation to promote reflex defection. Medical Alert Card for Autonomic Dysreflexia The bearer of this card, , is at risk for autonomic dysreflexia, a lifethreatening complication of spinal cord injuries above the T7 level. It is caused by an exaggerated sympathetic nervous system response to a noxious stimulus below the level of injury. The usual etiologies of AD are inadequate emptying of the bladder, a full bowel, tight clothing, ingrown toenail, etc. Fold The symptoms can include elevated blood pressure, headache, nasal congestion, bradycardia, and flushing [above the level of injury]. Please note the normal blood pressure for an SCI patient is 90/60. If the AD is unresolved, it may result in myocardial infarction, stroke, retinal hemorrhage, or death. It is essential that the source be identified and the elevated BP be resolved immediately. Please see reverse of card for details of treatment. 3. 4. 5. Fold 6. If systolic blood pressure (SBP) is above 160, apply one inch of nitro paste to hairless skin, and cover with clear occlusive wrap. 7. If elevated SBP continues, apply one additional inch of nitro paste to equal two inches. 8. Wipe off nitro paste when SBP decreases to 130. 9. If SBP remains elevated despite two inches of nitro paste, give 10 mg of hydralazine. If SBP remains elevated after 10 minutes, give an additional 10 mg of hydralazine. 10. If SBP remains refractory to the above treatments, give 10 mg of bite-and-swallow nifedipine. If nifedipine is given, the patient is at risk for hypotension once the AD is controlled and must be monitored closely for several hours after administration of nifedipine. Fold Section 1: How SCI Aﬀects Your Body! | [ 63 ]

http://www.pva.org/CPGs

Yes You Can - Fourth Edition

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