外科急诊创伤(英文)-自主反射障碍

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1、AutonomicDysreflexiaLeaugeayWebreBS,CCEMT-P,NREMT-PWhatisit?Anemergencyconditionthatrequiresimmediateattention!IsmostlikelytooccurinapatientwithaspinalcordinjuryatoraboveT-6AnabnormalresponsetoaproblemsomewherebelowtheinjurylevelandusuallyduetobowelorbladderproblemsScenarioYouareinthemiddleofaro

2、utinetransferofapatientwithanonacuteSCIatT-6YounoticeyourpatientisbecomingflushedanddiaphoreticHeiscomplainingofapoundingheadacheGoosebumpsappearabovetheinjurysiteThepatientisanxiousandc/otightnessinhischestYouhadjustinitiatedaBPcheckwhichis20mmHgabovethelastoneof110SBPFortunatelyforbothyouandyo

3、urpatientyouhadrecentlybeeninservicedonautonomicdysreflexiaandyouimmediatelysuspectthislifethreateningconditionCommonCausesOverfullbladderorbowelAnybindingsbelowthesiteofinjuryCathetertapedtolegPressuresoresContactwithhardorsharpobjectsDVT’sorPEInjuriesTootightclothing,appliances,shoesExtremetem

4、peraturechangesPathophysiologySomethingiswrongwhichcausesthebodytosendmessagestothespinalcordThespinalcordattemptstosendthemessagebuttheSCIblocksitTheautonomicNSisactivatedwhichcausesvasoconstrictioninthelegsandabdomenExtrabloodisforcedintotherestofthebodycausinganabruptincreaseinsystemicBPBaror

5、eceptorstellthebrainthattheBPisgettingtoohighanditsendsoutimpulsestodecreasetheBP:slowingHRvasodilationinface,neckandupperchestattemptstodilatevesselsbelowSCIbutthemessageisblockedBPcontinuestoriseresultinginstroke,cardiacarrestanddeathManagementImmediatelyraiseheadto90%andlowerlegsLoosenorremov

6、eanytightclothingorappliances,tapeetc...Emptycatheterbags,assessforkinksAssessBPq5minutesConsidermedicationsforBPcontrolConclusionYouareabletoappropriatelymanageyourpatientanddivertbacktotheERforreevaluationofyourpatientAllthestaffisexcitedtoseeyouandbringsyoucookiesandasoftdrinkDispatchsaysyouh

7、avemessedupthetransportrotationofnon-emergenttransfersWell,yourpatientlikesyouanyway...