Learning Objectives
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Describe the pathophysiology of autonomic dysreflexia.
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Recognize signs and symptoms of autonomic dysreflexia.
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Describe prevention and treatment of autonomic dysreflexia in labor.
Pathophysiology
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Occurs in 85% of women with spinal cord injury at level of T6 or above
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When the woman experiences a painful stimulus below the level of the spinal injury (such as from contractions or even a full bladder), she may not be conscious of the pain but it is still perceived by the sympathetic nerve fibers
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Because the sympathetic nerve fibers in the spinal cord are separated from their normal inhibition from the brain, the painful stimulus results in a hypersympathetic response ( Fig. 27.1 )
Fig. 27.1 Spinal cord injury prevents descending regulation of efferent sympathetic spinal neurons. Therefore, noxious stimuli result in a reflexic hypersympathetic response. - •
This hypersympathetic response results in dangerously elevated blood pressure, cardiac arrhythmias, and other symptoms ( Fig. 27.2 )
Fig. 27.2 Symptoms of autonomic dysreflexia.
Technical and nontechnical skills for autonomic dysreflexia.
Signs and Symptoms
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Severe hypertension
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Cardiac arrhythmia (bradycardia, atrial fibrillation, premature ventricular contractions, conduction abnormalities)
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Hyperthermia
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Sweating
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Flushing
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Dilated pupils
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Increased spasticity
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Seizures
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Stroke
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Coma
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Death
Management
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Remove noxious stimulus
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If the bladder is distended → drain it
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If clothing is too tight → loosen it
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If the stimulus is labor pain → initiate epidural early in labor and continue for 24–48 hours postpartum
Simulation Checklist
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