Autonomic dysreflexia: guidelines for practice

Abstract

Critical Care Nursing in Europe Vol 2 No 1 Spring 2002 13 INTRODUCTION Until the turn of the 20th century, a spinal cord injury (SCI) was considered to be fatal. In the First World War, about 90% of spinally injured people died. By the 1960s, about a third of all tetraplegics still did not survive (Spinal Injuries Association 1998). Today, the management of the spinally injured patient, involving a multidisciplinary and integrated approach, is greatly improved. The causes of early death, such as bladder and kidney infections, can be prevented and more patients with spinal injuries are surviving (Spinal Injuries Association, 1998). Annually, there are about 10–15 new SCIs per million of the population in the UK, which approximates to about 750–1000 new patients per year (Swain and Grundy, 1996; Spinal Injuries Association, 1998). In the UK, it is impossible to find out the exact incidence of patients with spinal injuries because cases of SCI do not have to be notified to the Department of Health and there is no central register of these injuries (Spinal Injuries Association, 1998). Hambly and Martin (1998) state there are about 40,000 spinal cord injured patients in the UK, most of which have been caused by a physical injury, ranging from road traffic accidents to sporting accidents (Hambly and Martin, 1998). Although patients with SCI are mainly looked after in special units, many will be admitted to an intensive care unit (ICU) at some point in time. Such patients may be admitted to an ICU for emergency care and stabilisation, following the onset of complications, such as respiratory failure, or following surgery, such as spinal fixation. Spinally injured patients can present many challenges for nursing care: physical, psychological and social. Although most general ICUs do not admit significant numbers of spinal patients, it is important that nurses are fully aware of their needs and potential complications. Certain complications related to SCI may lead to acute situations that can be seriously damaging to the health status of paralysed individuals and may lead to death. Autonomic dysreflexia, also known as hyperreflexia, is one of these acute medical emergencies.