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WHAT IS AUTONOMIC DYSREFLEXIA (AD)?

 An amplified sympathetic response from a stimulus (pain, irritant,


etc.) that cannot be resolved by the parasympathetic system
due to a blockage in the spinal cord from an injury above or at
the level of T6.
 Autonomic dysreflexia result from various noxious stimuli which
inturn trigger sympathetic hyperactivity.
Click the
corresponding arrow
Yes anything
T6 and on the diagram
above!
where autonomic
dysreflexia can occur
if the injury is on or
Yes T6 and above this level?
above!
Exactly! T6 or
above!
No review
this slide

SPINAL ANATOMY REVIEW:


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this slide

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this slide

Chart reproduced with permission from the site owner of www.spinalinjury.net


Image available at: http://www.spinalinjury.net/html/_spinal_cord_101.html
PATHOPHYSIOLOGY OF AUTONOMIC
DYSREFLEXIA
Stimulus below the spinal
cord injury (pain, irritation, What part of the PNS will be activated in
etc.) response to the accumulation of these
blocked nerve firings?

Click on correct answer:


Nerves fire and signals are
sent up the spinal cord

Para-
Sympatheti
c
Signals are blocked in the Sympathetic
No! This is
CORRECT!
spinal cord by the level of activated
later!
injury and flow out the
“sphlanchnic outflow”
(Travers, 2009 )
PATHO OF AUTONOMIC DYSREFLEXIA
CONTINUED:
Severe
Sympathetic vasoconstriction
Blood pressure
nervous system is of blood vessels
rises
activated below the level
of injury!

Bradycardia from Parasympathetic


the system activates
parasympathetic from
system activating baroreceptors
the vagus nerve sensing high BP!

(Porth & Matfin, 2009,


p. 1293).

Microsoft clip art 2007


PUTTING AD TOGETHER:

 Stimulus below the injury


 Nerve signals from that stimulus are sent
 Signals blocked at injury point
 Sympathetic nervous system activated - Hypertension
 Parasympathetic nervous system is activated but can only
reach to the level of injury.
Click box when you are ready for the answer :

What will happen to Mr. Z’s heart rate?

(Porth & Matfin,


2009, p. 1293)
AD’S INFLUENCE ON THE

 Bradycardia
 Significant Atrial Distention:
SNS Atrial
BP activatio Distention (Microsoft Office Clip Art, 2007)

n and
release of
Atrial
Natriuretic
Peptides

(Porth &
Matfin, 2009)
SIGNS AND SYMPTOMS:

 Besides bradycardia, hypertension, and a flushed face; what else


might Mr. Z have?
*Click on each sign/symptom for more information*
headac Goose Blotchy Blurred
sweating
he bumps skin vision

Cool
nasal periphera
Feeling Pupils
congesti l
of doom constrict
on extremitie
s

(Porth & Matfin, 2009, pg. 1293)


THE 3 COMMON CAUSES OF AD:

#3 Skin
impairment
*Rule out each cause
by working from the

#2 Full bottom up! Start with


the most common

Bowel
cause first!

#1 Full
Bladder
(Travers, 2009)
LESS COMMON CAUSES OF AD:
 Pregnancy/uterine contractions
 Procedural/post surgical pain or inflammation (*Anesthesia
should be considered for major procedures/surgeries despite
altered sensations from the paralysis)
 Fractures
 Bladder stones
 Cystitis

(Microsoft Office Clip Art, 2007)


(Louis Calder Memorial Library of the University of Miami/Jackson Memorial Medical
Center, 2009)
URINARY MANAGEMENT/BLADDER
ASSESSMENT IN AD:
*If the patient does not have an indwelling catheter – insert one
(use 2% lidocaine lubricant into the urethra)
*If a catheter is already in place, assess for kinks and patency of the
catheter
(if patency is questionable place a new
foley).

(Travers, 2009) (Microsoft Clip Art, 2007)