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Thread: URGENT - Help with Autonomic Dysreflexia

  1. #11
    Both can occur with AD. High heart rate occurs from the AD, and then it can drop very low with treatment. There is the risk of heart irregularities from too low and stroke from too high. Hopefully the download for Professionals can help the doctor, I am sorry it wasn''t available in Spanish. The one for consumers in Spanish is only in hard copy and not PDF.

    I am not a nurse or doctor but it seems like from what you described, AD is a strong possibility.
    Every day I wake up is a good one

  2. #12
    Super Moderator Sue Pendleton's Avatar
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    The best person to get to is often the anesthesiologist. Local primary and general care docs often don't know a thing about AD but the people who put you out do. So hunt down the chief of that department and ask for a moment of his time.

    It also sonds like he may have had a quadrupling of the effect of the 2 meds he took instead of a doubling. Nifenidine (sp?) is the bite into liquid capsule that is used in emergencies by many. That may have been enough for the short time it works and the other pill overlapped with it taking his pressure down so low.

    I doubt it's the case here but a fast pulse goes with infection as the body tries to fight it off. But it sounds like his toe was healing. Let us know how things go.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  3. #13
    OK. I just got back from the hospital. The doctors disregard AD. They claim that since he injured his toe ten days ago, AD should have ocurred then and not now. I argued that you can get a UTI 20 times without AD, and get AD on the 21st. His heart rate dropped to below 30 bpm while I was in the room with him. I manually checked his bpm and it seemed to coincide with the <30 bpm reading. After a minute or two it went back up to the mid 50´s. His wife finally convinced the doctors to give him a local anesthetic since they had nothing to lose. We´ll see what happens.

    He went in at around 6 am with what he felt was a heart attack, chest pressure, blood pressure over 170/125 and they documented arythmia (sp) with bpm in the 160 bpm range. The drs discarded every possible cause but dysreflexia, now they think it is stress related or literally "he drank too much coke".

    His wife is going crazy. I took 10 papers and booklets kindly sent by BM at C. Reeve and they have that very low in their list of possible causes.

    He is still in intensive care. Any comments or suggestions??
    T6 complete (or so I think), SCI since September 21, 2003

  4. #14

    another autonomic dysreflexia question

    I posted an episode of a good friend on another post. I have a question.

    Has anyone badly hurt a toe or something else below the level of injury and not gotten AD, but got an AD episode days later while the injury is still in the healing process?? Perhaps from banging it or a popped blister or some other cause??

    Is it possible to get AD days after having very strong stimuli below the level of injury without getting it at first??
    T6 complete (or so I think), SCI since September 21, 2003

  5. #15
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    The time frame is closer, but I had part of my toenail removed in the podiatrists office, with no problems, yet started with AD a few hours later. TAking my shoe off ended the episode. I was surprised as I had not had any AD during the surgery.

    I will also occasionally have beginning symptoms of AD, and attribute it to my bladder, cath (a certain amount) and have it resolved. Yet other times I cath higher volumes, with no signs of AD. I think our bodies don't always respond the same way to the same stimulus.
    T7-8 since Feb 2005

  6. #16
    Are you sure the toe is healing and is not inflammed or infected? Ingrown toenails (which are inflammed or infected) are notorious for causing AD, and certainly tearing off a nail can cause similar type pain.

    I am sorry you are having so much trouble. At least in the USA I could threaten physicians with a suit if they did not follow published clinical practice guidelines such a those for AD from the Consortium. Unfortunately I suspect that the physician where you practice primarily from the paternalistic model, and are not used to listening to patients or their advocates. Have you at least tried going over their heads to the medical director or director of the hospital?

    I am combining your two threads on this same topic.

    (KLD)

  7. #17
    Thanks. Other than the blister it looks like it is healing fine. His family finally convinced the doctors to administer local anesthetic. They tell me he had a good night without blood pressure or heart rate fluctuations, but I have to go to the hospital to be sure.

    This is my first time facing possible AD, on me or anyone else. What I know for sure is that his blood pressure went sky high and so did his heart rate, drugs were administered and 12 hours later his heart rate was still dropping below 30 bpm, but by then his blood pressure was stable at around 110 over 60 or so while I was there. Is it possible from AD for the heart rate to go down without blood pressure going up?? Also, when his heart rate dropped below 40 or so and then below 30 he would have very strong spasms but did not feel ill.

    His injury 10 days ago was much worse than a torn toenail. His pinky toe got stuck while putting on his shoe and the whole toe was almost torn off and required ten stitches. When this happened he found out hours later and did not AD. Then while the toe was swollen it rubbed against the adjacent finger or something else and got a blister, which popped before the possible AD incident. Doctors insist it is not AD, but his wife told me this morning that he had a much better night and that everything was stable after the anesthetic was administered.

    Thanks for everyones help.

    Quote Originally Posted by SCI-Nurse
    Are you sure the toe is healing and is not inflammed or infected? Ingrown toenails (which are inflammed or infected) are notorious for causing AD, and certainly tearing off a nail can cause similar type pain.

    I am sorry you are having so much trouble. At least in the USA I could threaten physicians with a suit if they did not follow published clinical practice guidelines such a those for AD from the Consortium. Unfortunately I suspect that the physician where you practice primarily from the paternalistic model, and are not used to listening to patients or their advocates. Have you at least tried going over their heads to the medical director or director of the hospital?

    I am combining your two threads on this same topic.

    (KLD)
    T6 complete (or so I think), SCI since September 21, 2003

  8. #18
    An update. Last week they found two clots either on the carothide arteries or the jugular vein. This compounded with everything else, my friend and his wife decided to go to the Mayo clinic in Jacksonville, Fl. for a full check up and treatment. This started yesterday.

    They found the almost detached (and reattached) finger fully infected and the infection was beginning to spread. It seems to be responding to whatever antibiotic they are giving him. Who knows what would have happened if they did not find the clots and he would have stayed here.

    Now it seems that AD is more of a possibility if Atrial Fibrillation (which they found upon first arrival to the emergency room) can result from high blood pressure or from other AD symptoms.

    Thanks for everyone´s help. Keep any further comment coming please.
    T6 complete (or so I think), SCI since September 21, 2003

  9. #19
    Here is a great reference on AD

    http://www.spinalcord.org/html/facts...ysreflexia.php

    and you are right, there are many things in your friend that canb e causing the AD such as the toe, the pain,etc- but bowel and bladder should also be checked. The fact that your friend was given 2 blood pressure lowering meds in a short time can make the BP go too low and that can be dangerous-on top of getting medication to bring the Blood Pressure back up. Unfortunatley, aD requires a tricky balance.

    The pulse usually goes down but not always but they were right in ruling out other arrythmias. With a pulse of 160, and if it persists, they have to look for other things.

    I know sometimes you have to be plain obnoxious and unrelenting to make people listen about AD. It would be good if your friend had a primary care sCI doctor that coudl be clalled in these tuypes of situatiosn that could guide the ED and the ICU.

    Do you have other questions? Please keep us posted.

    AAD

  10. #20
    AAD~ The link says BP greater than 200/100. I thought AD was also based on a persons baseline pressure. An example, if your baserate is 112/70 and your pressure increases to 180/98 and you have other AD symptoms, then you are in fact having AD. The PVA guide defines AD as 30-40 points over baseline. Am I wrong or is the NSCIA link wrong. My doctor has me treating my AD based on blood pressure above baseline.
    Every day I wake up is a good one

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