Autonomic dysfunction in SCI
Types
- autonomic dysreflexia
- OH
- thermoregulatory
- cardiac dysrhythmias
- bladder, bowel, and sexual dysfunction
Autonomic dysreflexia (AD)
- pts w/ lesions at ≥ T6 (sympathetic tone)
- triggered by noxious stimuli below the level of pts injury (unopposed sympathetic activation)
- fatal if not treated (AMI, stroke)
- usual presentation is throbbing headache, sweating, blurry vision, brad/tachy, spikes BPs
- causes
a. classical distention of hollow viscus (organs w/ air inside, like GUT)
- bladder scan and cath immediately is enough to stop
- bowel impaction and manual disimpaction, teach pts
- educate pts about avoiding AD
b. gentle stimuli due to tight clothes (shoes, belt, compression socks)
c. menstrual cramps
d. ulcers and wounds
- treatment
> remove stimuli
> nitro-paste 1 inch (above the pts level lesion)
> anti-HTN rapid-onset: nifedipine, captopril, prazosin