Autonomic Dysreflexia (Adult)

Question 1

What are the care objectives for Autonomic Dysreflexia?

Answer 1

None

Question 2

Recite the Autonomic Dysreflexia flow chart

Answer 2

Question 3

What is the management for autonomic dysreflexia?

Answer 3

Question 4

What are the primary emergency indications for GTN?

Answer 4

Question 5

What are the contraindications for GTN?

Answer 5

Question 6

What are the precautions for GTN?

Answer 6

Question 7

What are the side effects for GTN?

Answer 7

Question 8

Why do we use GTN in AD?

Answer 8

• Autonomic dysreflexia causes extreme vasoconstriction → leading to HTN
• GTN causes vasodilation refusing the pressure
• Its fast acting

Question 9

Does the O2 therapy guideline apply to this presentation in AD?

Answer 9

N/A - unless evidence of hypoxaemia

Question 10

Are there any relevant CWI’s that relate to AD?

Answer 10

N/A

Question 11

What are 3 differential diagnoses for Autonomic Dysreflexia?

Answer 11

• Autonomic Dysreflexia
• Hypertension
• Sepsis/infection (although often low BP)

Question 12

What are the care pathways for AD?

Answer 12

• Reassurance
• Transfer to the nearest appropriate hospital
• Transport the patient even if the symptoms are relieved as this presentation meets the criteria of autonomic dysreflexia a medical emergency that requires identification of probable cause and treatment in hospital to prevent cerebrovascular catastrophe
• If SBP remains >160mmHg
• GTN SL
• Repeat initial dose of GTN at 10 min intervals until either
• Symptoms resolve
• Onset of side effects
• BP <160mmHg
• Reassessment

Question 13

What are some extrication considerations for AD?

Answer 13

• Position patient upright and lower legs if possible
• Elevate HOB
• To induce orthostatic hypotension and reduce blood pressure

Question 14

What are some escalation considerations to note?

Answer 14

• What is your scene time?
• How far is MICA - am I waiting or loading and going?
• How far is the hospital?

Question 15

What are some secondary surveys for AD?

Question 16

Is a patient presents with hypotension, headache, nausea and diarrhoea, which of those are considered adverse effects of GTN administration?

Knowledge question

Answer 16

• HA
• Hypotension

Question 17

How do you confirm AD?

Answer 17

• Previous SCI at T6 or above
• Severe headache
  AND/OR
• SBP >160

Question 18

In the CPG it states identify and treat the possible causes - what are the possible causes and how do you treat them?

Answer 18

• distended bladder (common) > ensure IDC is not kinked
• Manage pain > e.g. #’s, burns, labour

Question 19

What do you do if the SBP remains > 160?

Answer 19

• GTN 300mcg S/L (no prev admin)
  OR
• GTN 600mcg S/L

Question 20

What do you do if you get an adequate response from your treatment?

Answer 20

• Transport to the nearest hospital

Question 21

Do you need to transfer someone with AD to a specialist facility?

Answer 21

• No you can just transport to the nearest hospital

Question 22

What do you do if there is an inadequate response to the initial dose of GTN?

Answer 22

Repeat inital dose of GTN at 10 minute intervals until either:

• Symptoms resolve
• Onset of side effects
• BP <160

Transport to the nearest hospital

Question 23

When do you stop treatment with GTN?

Answer 23

• Symptoms resolve
• Onset side effects
• BP <160