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Thread: emergency AD kit?

  1. #1
    Senior Member alan's Avatar
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    emergency AD kit?

    Since bad autonomic dysreflexia is something that can strike anyone who can get AD, and isn't always caused by something that can be quickly resolved, what should we all have closely available to control the worst symptoms while the cause is being determined and treated?

  2. #2

    AD kit

    If you are vulnerable to AD, having an AD kit is strongly encouraged. This is addressed in the consumer version of the clinical practice guidelines for AD management from the Consortium for Spinal Cord Medicine:
    Autonomic Dysreflexia: What you should know

    At the center where I work, we include the following:

    For all patients at risk:
    -Blood pressure cuff (manual or digital)
    -2% lidocaine jelly urethral applicators (Urojets), 5
    -Nifedipine, 10 mg. capsules, 10
    -For both intermittent cath and external catheter users, catheterization supplies
    -Our AD management wallet card
    -Our AD management home care procedure

    In addition, for those who have an indwelling catheter:
    -Catheter irrigation set, 3
    -Normal saline (0.9% NaCl) irrigation solution, 2 bottles

    Some patients are provided with nitroglycerine paste as well, but we have to caution them that this should never be used within 24 hours of using Viagra.

    (KLD)

  3. #3
    Senior Member alan's Avatar
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    Thanks for the list. What about something like clonidine patches for the blood pressure? Is that what the Nifedipine is for?

  4. #4
    Treatments for "chronic" AD (which cannot be made to go away due to the cause, such as pressure ulcers, fractures or surgery) might include a clonidine patch, but its absorption is too slow for emergent use. Other than nifedipine, the other medication that are not given IV for emergent AD include nitropaste and captropril (from one study only).

    I would add to the list an additional indwelling catheter and insertion tray for those who are able to change their catheter at home, as this may be required if the catheter cannot be irrigated and made patent.

    We have our patients call us PRIOR to taking any of the medications, and then after we have made sure they have taken the correct actions to check the bladder, bowel, skin etc. we may instruct them to take their nifedipine. If so, we also instruct them to have someone else drive them or take an ambulance to the hospital.

    AD from an undetermined cause is not something that should be treated at home on your own, as the cause itself may be life threatening.

    (KLD)

  5. #5
    I HAVE HAD SOME BAD BOUTS WITH AD AND I USE NITROLINGUAL 0.4MG SPRAY AFTER CHECKING B.P. 1 SHOT UNDER TONGUE

  6. #6
    The same precaution about not taking Viagra within 24 hours (before or after) applies to all forms of nitroglycerine, whether pills, spray or ointment.

    (KLD)

  7. #7
    Senior Member alan's Avatar
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    <qoute>

    For all patients at risk:
    -Blood pressure cuff (manual or digital)
    -2% lidocaine jelly urethral applicators (Urojets), 5
    -Nifedipine, 10 mg. capsules, 10
    -For both intermittent cath and external catheter users, catheterization supplies
    -Our AD management wallet card
    -Our AD management home care procedure

    <quote>

    Any way that any of us here can get the latter two items on this list?

  8. #8
    Originally posted by alan:

    <qoute>

    For all patients at risk:
    -Blood pressure cuff (manual or digital)
    -2% lidocaine jelly urethral applicators (Urojets), 5
    -Nifedipine, 10 mg. capsules, 10
    -For both intermittent cath and external catheter users, catheterization supplies
    -Our AD management wallet card
    -Our AD management home care procedure

    <quote>

    for card: call paralyzed veterans of america or the eastern pva (718-803-3782, ask for research and education dept)

    Any way that any of us here can get the latter two items on this list?

  9. #9

    AD materials

    The AD card is fairly specific to our center...it lists our phone number to call for more information, so I would be reluctant to give it out for those who are not our patients. You can get a good "generic" card from the Consortium for Spinal Cord Medicine, and you should check with your original or local SCI center to see if they have one. I can share the content, but not the cards if people want that.

    For anyone who wants the actual patient handout we have on AD, please send me a private message with your e-mail address and I will forward you a Word file of this handout.

    (KLD)

  10. #10
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    temporary AD relief-try IV or IM Demerol

    I've mentioned this before but I was able to control severe, cause unknown, AD with accompanying extra severe spasms and out of sight BP with numbers in the 240/140 range with a 50mg IV or 75mg IM dose of Demerol. Literally nothing including morphine, valium, toradol, fentanyl did a thing.Something about the Demerol gave near immediate relief to all symptoms including the high BP. My Doctors said the Demerol may have saved my life cuz this went on for over a year before the pump.I spent as much time in the ER and ambulance as I did at home. They never did find the cause.Maybe it was unique to me or maybe it should be on the list of temporary relief meds.WR

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