Orthostatic Hypotension and AD

Question 1

What is the most common timeframe for when patient’s experience autonomic dysreflexia

Answer 1

Within 1 year of injury

Question 2

At what level of lesion can patients not regulate and maintain body temperature

Answer 2

T8 and above

Question 3

What 2 complications are SCI patients with lesion above T8 at risk for?

Answer 3

Orthostatic hypotension

Autonomic dysreflexia

Question 4

Mechanism of orthostatic hypotension in SCI patients

Answer 4

Aortic and carotid baroreceptors sense a decrease in BP, however sympathetic efferent pathways are interrupted in SCI and brainstem is unable to send message to increase BP = hypotension

Question 5

How much of an increase in BP occurs in autonomic dysreflexia?

Answer 5

20-40 mmHg above reference range

Question 6

3 main pharmacologic treatments for autonomic dysreflexia

Answer 6

1. Nitropaste
2. Clonidine
3. Nifedipine

Question 7

What level of SCI do you have impaired vs absent sympathetic innervation to the heart

Answer 7

≥T6 lesions = impaired

≥ T1 lesions = absent

Question 8

First aspect of treatment in autonomic dysreflexia

Answer 8

Sit the patient upright

Question 9

What 2 oral medications can be used for orthostatic hypotension

Answer 9

Midodrine (alpha-1 agonist)

Florinef (mineralocorticoid)

Question 10

What do vital signs show if someone is in autonomic dysreflexia

Answer 10

HTN and bradycardia

Question 11

At what point do you administer medications for autonomic dysreflexia

Answer 11

If BP > 150

Question 12

How do you prevent autonomic dysreflexia during labor?

Answer 12

Spinal anesthesia

Question 13

How long after injury can patients experience autonomic dysreflexia?

Answer 13

2-4 weeks post-injury