Spinal Injuries and Autonomic Dysreflexia

Water Removal Techniques for Spinal Patients

Lifeguards are trained in water removal techniques for spinal patients.
They learn to maintain spinal alignment while the patient is in the water.
A lifeguard can tread water while a paramedic supports the patient, slipping their arms under the patient's arms and holding their head to maintain alignment.
This requires strong legs to tread water effectively.

Paramedics typically do not enter burning buildings; fire agencies take the lead.
Entering swimming hazardous environments (lakefront, river, pool) is generally outside the scope of practice.
Employers have policies regarding the level of risk paramedics should take in such scenes.

Helmets must be removed in cases of head injury or suspected spinal cord injury.
A proper patient assessment cannot be performed with a helmet on.
Helmets cause flexion due to the occiput contacting the backboard, preventing neutral alignment.
Helmet removal while maintaining spinal alignment is a skill taught in the program.

In Ontario, medications are typically not used for spinal cord injury patients in BLS care.
The American Association of Neurological Surgeons recommends that steroids not be administered in the management of acute spinal cord injuries.
Steroids are anti-inflammatory and their use is a decision for neurologists and neurosurgeons, considering complications and costs.

Long-term, patients who survive the initial spinal cord injury often die of pneumonia or sepsis from bladder infections.
Impaired coughing reflex and supine position make them vulnerable to pneumonia.
Lack of mobility hinders pathogen removal from the lungs.
The immune system's ability to compensate is limited, making these patients susceptible to infections.

Autonomic dysreflexia is an in-hospital complication for spinal patients.
It occurs when the bladder gets full, triggering adrenaline release and acute hypertension because the patient lacks bladder control and sensation.

Autonomic dysreflexia affects individuals with spinal cord injuries above the T6 level.
It is a condition where the autonomic nervous system becomes overactive.
The overstimulated autonomic nervous system causes the body to slow the heart rate, raise blood pressure, and narrow blood vessels.
This is an exaggerated sympathetic fight or flight response.

The autonomic nervous system controls heart rate, blood pressure, and breathing.
In individuals with spinal cord injuries above T6, nerve signals from the lower body cannot reach the brain but reach the autonomic nervous system.
The autonomic nervous system overreacts to stimuli, releasing chemicals that constrict blood vessels and raise blood pressure.
The brain tries to slow down the heart rate to control the blood pressure.

Diagnosed during an episode through physical examination and medical history.
Doctors check blood pressure and look for signs of sweating, flushing, or redness.
Blood tests may be performed to rule out other conditions.
Treatment focuses on avoiding triggers like a full bladder or tight clothing.
Medications like beta blockers or calcium channel blockers may be prescribed to lower blood pressure.

Autonomic dysreflexia can increase the risk of strokes by three to four times.
The outlook for patients can be uncertain if the condition is triggered by uncontrollable factors.
Patients should work with doctors to identify and avoid triggers.

Autonomic dysreflexia, or autonomic hyperreflexia, is an exaggerated reflex response by the sympathetic nervous system.
It occurs due to an irritating stimulus below the site of spinal cord injury.
Patients with T6 or higher injuries are at the highest risk.
The sympathetic nervous system reflex is unopposed by the parasympathetic nervous system, leading to severe hypertension.
Uncontrolled autonomic dysreflexia can lead to stroke, seizure, or fatality.

Normal physiology is disrupted (e.g., emptying the bladder), but the spinal cord injury prevents the brain from recognizing the issue.
Chemical reactions lead to catecholamines in the bloodstream, causing hypertension.
Hypertension creates a risk of stroke.
In spinal cord units, autonomic dysreflexia may result from a slipped or blocked catheter, leading to bladder distension.
Pre-hospital, awareness of the condition is important, especially during inter-hospital transfers of spinal patients.

Spinal injuries can be nontraumatic, resulting from tumors in the spine (spinal cancer).
Osteocytes can grow to the point where they create a pathological fracture.
Pathological fractures can cause spinal cord vulnerability, leading to numbness, tingling, or paralysis.
Patients with spinal cancer often have an early diagnosis due to excruciating pain.
Spine cancer can be secondary to other cancers, such as prostate cancer in males, due to the proximity of the prostate to the lumbar spine.