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URGENT - Help with Autonomic Dysreflexia

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    URGENT - Help with Autonomic Dysreflexia

    A very good friend is in the intensive care unit of a local central american hospital. This is the situation:

    He is a C6/C7 incomplete around thirteen years post.

    His attendant while putting on shoes ten days ago, inadvertently forced the shoe on and almost tore the pinky toe off of his foot. The toe required 10 stitches to be attached. No broken bones. He found out about the mishap hours after it happened and had no sypmtoms of AD.

    This morning he woke up with chest pressure and heavy spasms. His blood pressure was more than 170 over more than 120, the chest pain continued and he went blank (started seeing black). His wife gave him an aggressive liquid blood pressure reducing medicine (don´t know exactly what but can find out) and a blood pressure reducing pill.

    After a while his blood pressure dropped to 70 over 40 or so and his wife took him to a local intensive care unit.

    I just came back from the hospital. I was able to go in and see him. His blood pressure was 120 over 80, but while I was there it went up to 170 over 100 for a few minutes, then back down to 120 over 80. I found out that they are giving him medication to INCREASE his blood pressure.

    This really concerned me because it is very likely that his blood pressure dropped due to the medication, and that the increase in blood pressure and spasms may be due to AD. If that is the case, then medication to increase blood pressure may be really dangerous (I think, please comment).

    They have ruled out DVT (had a doppler done), they ruled out Thyroid (I don´t know why but they wanted to check that) and are now doing an ECG (ecocardiogram - sp!) to rule out heart problems. They cathed him and his BP routine has been normal.

    I suggested that they give him a local anesthetic to bring the pain on his pinky finger down, just in case. Is that ok??

    What else can he do?? It seems that the local doctors that are treating him know nothing about AD. In my opinion they may be treating the symptoms but not the cause, which may be the toe.

    Can you get chest pain or pressure from AD??

    Please comment URGENT!!! KLD???
    T6 complete (or so I think), SCI since September 21, 2003

    #2
    PARA, can you copy something from this site or off the Internet explaining AD, I have found many small local hospitals don't know anything about AD over my 20 + years injured. The thing is once they read it, they comprehend it pretty immediately. I believe nitro paste is the quickest thing to bring down BP.

    good luck

    Comment


      #3
      I printed something from the PVA. It explained what it was, symptoms, etc. I suspected AD so I took it with me. They seemed to pay very little attention to it and continued with what they have been "schooled" to do.

      I believe that they are treating the symptoms and not the cause. They were paying no attention to the toe. It seemed healthy, no infection, but had a popped blister from I guess friction with the other toe.

      Could it be that he got no dysreflexia when the toe was torn and get it later from a blister or from banging it while sleeping??
      T6 complete (or so I think), SCI since September 21, 2003

      Comment


        #4
        That's disappointing and frustrating to hear. I can't stand doctors that don't listen to the patient. Its vital with people like us, Drs. aren't "schooled" all that much on AD, OR the intricacies of sci people. My brother is a Harvard guy, and is married to a very smart doctor educated at Harvard & Oxford, and she is always interested in asking questions about my care & problems that arise.

        I would certainly think it would be possible to develop AD, AFTER the injury. Positioning could cause the ad now, maybe when pressure is on it now he gets the increased bp

        Comment


          #5
          His eco came back clean. Now what???
          T6 complete (or so I think), SCI since September 21, 2003

          Comment


            #6
            para, years ago I had a Ingrown toe nail, and I had extreme AD, AS you say, if his toe was nearly ripped off I certainly could see AD being a issue.

            Comment


              #7
              I sent you a message

              Let me know if you want the electronic versions and I will send them ASAp. Yes, pain medication would help control the symptoms of AD. It is quite likely the pain that is triggering the episode.
              Every day I wake up is a good one

              Comment


                #8
                Originally posted by paramoto
                I suggested that they give him a local anesthetic to bring the pain on his pinky finger down, just in case. Is that ok??

                Can you get chest pain or pressure from AD??
                I think that was an excellent suggestion to give him a local anesthetic. When I went in for my bladder augmentation the anestesiologist suggested that not only should I be put under but because of the extreme ad that comes with my bladder that they were going to give me a spinal as well. I didn't like the idea but agreed to it and was very comfortable with the fact that the dr. was educated enough to understand the possible implications.

                I am sure the toe could give him ad. I have had a pressure sore on my butt and many times it would give me a slight headache and the goosebumps.

                I'm not sure if ad can give you chest pains but it certainly can make your chest feel quite tight and a strong pulling. When my bladder spasms I get those chest feelings along with goosebumbs and you can even see my lips turn white until the spasm has subsided.

                Please keep on them with checking out the toe. He is lucky to have you and someone has to push them into understanding what ad is all about. Good Luck.

                Comment


                  #9
                  Cheesecake, I already pm´d you. Thanks.

                  Everyone else, thanks for the comments. Keep them coming.
                  T6 complete (or so I think), SCI since September 21, 2003

                  Comment


                    #10
                    Cheesecake. Thanks. Got all the info and was able to print it fine. No need to fax international long distance. Thanks.

                    I just found out that his heart rate was at 160 bpm when he went in to the hospital this morning. The doctors say that he had arythmia (sp.) and they do not believe it is AD.

                    The high heart rate threw me off, as what I have read says heart rate may go way down with AD, not up (I am just printing and have not read Cheesecakes booklet, will do shortly in case it states otherwise).

                    Thanks again for all the comments.
                    T6 complete (or so I think), SCI since September 21, 2003

                    Comment


                      #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

                      Comment


                        #12
                        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.

                        Comment


                          #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

                          Comment


                            #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

                            Comment


                              #15
                              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

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