Page 169 - Critical Care Notes

4223_Tab05_141-174 29/08/14 8:28 AM Page 163

163
■ Avoid bowel impaction by administering stool softeners and establish
bowel control.
■ Prevent autonomic dysreflexia.
■ Provide IV fluids cautiously because they can precipitate heart failure as a
result of poor heart rate response to ↓ circulating blood volume. Administer
crystalloids and blood products as indicated.
■ Administration of methylprednisolone Na succinate within 8 hr of injury
(30 mg/kg IV over 15 min; infusion of 5.4 mg/kg/hr for 24–48 hr) remains
controversial and is associated with severe pneumonia and sepsis.
■ Administer vasodilators as needed: nitroglycerine, nifedipine (Procardia),
phenoxybenzamine (Dibenzyline), hydralazine or nitroprusside (Nipride).
■ Prevent sepsis and infections (respiratory, urinary tract, and wound).
■ Provide emotional support for patient and family.
■ Prepare patient for surgical management to reduce spinal fracture or
dislocation and decompression of the spinal cord:
■ Skeletal fracture reduction and traction with skeletal tongs or calipers,
skeletal traction device, and halo device
Autonomic Dysreflexia
Autonomic dysreflexia is also known as hyperreflexia. It occurs in people with
SCI at or above the level of T5–T7 and rarely as low as T8. It is considered a
medical emergency because it precipitates life-threatening HTN.
A stimulus causes ↑ sympathetic nervous system response below the level of
SCI and systemic vasoconstriction of blood vessels → bradycardia, sudden ↑ in
SBP and DBP, facial and neck flushing (reddening above the level of SCI) asso-
ciated with pale, cold skin on the trunk and extremities (below the SCI), sweat-
ing, anxiety, pounding headache, nausea, metallic taste, nasal congestion,
“goose bumps,” blurred vision, difficulty breathing, increased spasticity, and
chest pain. It may lead to CVA, renal failure, atrial fibrillation, seizures, and acute
pulmonary edema.
Causes
■ Numerous causes including fractures, surgery, diagnostic procedures, and
a variety of medical conditions
■ Bladder distention or spasm (most common cause); UTI
■ Bowel distention or impaction
■ Stimulation of anal reflex (stimulation of skin around the anus produces
contraction of the anal sphincter)
■ Gastric irritation including gastric ulcers or gastritis
■ Menstruation, vaginitis, sexual intercourse, ejaculation
■ Labor and delivery in women
NEURO