外科急诊创伤(英文)-自主反射障碍.ppt

Autonomic Dysreflexia Leaugeay Webre BS, CCEMT-P, NREMT-P What is it? An emergency condition that requires immediate attention! Is most likely to occur in a patient with a spinal cord injury at or above T-6 An abnormal response to a problem somewhere below the injury level and usually due to bowel or bladder problems Scenario You are in the middle of a routine transfer of a patient with a non acute SCI at T-6 You notice your patient is becoming flushed and diaphoretic He is complaining of a pounding headache Goosebumps appear above the injury site The patient is anxious and c/o tightness in his chest You had just initiated a BP check which is 20 mmHg above the last one of 110 SBP Common Causes Overfull bladder or bowel Any bindings below the site of injury Catheter taped to leg Pressure sores Contact with hard or sharp objects DVT’s or PE Injuries Too tight clothing, appliances, shoes Extreme temperature changes Pathophysiology Something is wrong which causes the body to send messages to the spinal cord The spinal cord attempts to send the message but the SCI blocks it The autonomic NS is activated which causes vasoconstriction in the legs and abdomen Extra blood is forced into the rest of the body causing an abrupt increase in systemic BP Management Immediately raise head to 90% and lower legs Loosen or remove any tight clothing or appliances, tape etc... Empty catheter bags, assess for kinks Assess BP q 5 minutes Consider medications for BP control Conclusion You are able to appropriately manage your patient and divert back to the ER for reevaluation of your patient All the staff is excited to see you and brings you cookies and a soft drink Dispatch says you have messed up the transport rotation of non-emergent transfers Well, your patient likes you anyway... * * Fortunately for both you and your patient you had recently been inserviced on autonomic dysreflexia and you immediately suspect this life threatening condition Baroreceptors tell the brain that the BP is