scholarly journals Komplikasi Autonomic Dysreflexia Pasca Cedera Medula Spinalis

2019 ◽  
Vol 8 (3) ◽  
pp. 207-16
Author(s):  
Dimas Rahmatisa ◽  
Iwan Fuadi ◽  
Sudadi Sudadi
Keyword(s):  
Spinal Cord ◽  
Functional Disability ◽  
Spinal Cord Injuries ◽  
Early Recognition ◽  
The United States ◽  
Recovery Phase ◽  
Autonomic Dysreflexia ◽  
Cord Injury ◽  
Life Threatening ◽  
Care Costs

Cedera medula spinalis merupakan kejadian yang sering dijumpai di Amerika Serikat, dengan biaya perawatan kesehatan seumur hidup yang tinggi berdasarkan tingkat kecacatan fungsional. Permasalahan yang timbul dapat berupa masalah psikologis, fisik, dan sosial, yang dapat menghabiskan biaya yang sangat besar. Tatalaksana kasus cedera medula spinalis terus menjadi tantangan pada tiap fase perawatan, mulai dari awal terjadinya cedera, hingga perawatan dan pemulihan pasca tindakan operasi, karena angka masuk ulang ke rumah sakit pasca perawatan tetap tinggi. Salah satu komplikasi cedera medula spinalis adalah adanya perubahan sistem saraf autonom dapat terjadi akibat kerusakan pada kontrol simpatis sehingga menyebabkan komplikasi yang dikenal sebagai autonomic dysreflexia (AD), yang muncul selama fase pemulihan. Manifestasinya dapat berupa hipertensi berat dengan bradikardia paradoks, kemerahan kulit, dan sakit kepala, penyakit ini dapat menyebabkan kecacatan jangka panjang dan gangguan kardiovaskular. Terapi untuk pasien dengan AD umumnya bertujuan untuk pemulihan gejala dengan cepat hal ini sangat penting karena karena dapat terjadi komplikasi parah yang mengancam jiwa bila gejala yang ada tidak ditangani dengan segera. Pencegahan yang tepat, pengenalan dini, dan manajemen akut adalah faktor penting dalam tatalaksana AD. Autonomic Dyreflexia Complication after Spinal Cord InjuryAbstractSpinal cord injury is a common occurrence in the United States, with high lifetime health care costs based on the level of functional disability. Problems that arise can be psychological, physical, and social problems, which can cost a lot of money. Management of spinal cord injuries continues to be a challenge in each phase of treatment, from the beginning of the injury, to treatment and recovery after surgery, because the rate of re-entry to the post-treatment hospital remains high. One complication of spinal cord injury is the presence of autonomic nervous system changes that can occur due to damage to sympathetic control resulting in complications known as autonomic dysreflexia (AD), which appears during the recovery phase. The manifestation can be life-threatening hypertension with paradoxical bradycardia, flushing, and headache, this disease can cause further long-term disability and cardiovascular disorders. Therapy for patients with AD generally aims to recover symptoms quickly this is very important because because there can be severe life-threatening complications if the symptoms are not treated immediately. Proper prevention, early recognition, and acute management are important factors in the maangement of AD.

scholarly journals Characterization of heart rate changes associated with autonomic dysreflexia during penile vibrostimulation and urodynamics

2021 ◽  
Author(s):  
Lauren Rietchel ◽  
Andrea L. Ramirez ◽  
Shea Hocaloski ◽  
Stacy Elliott ◽  
Matthias Walter ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Spinal Cord Injuries ◽  
Autonomic Dysreflexia ◽  
Cerebrovascular Complications ◽  
Elevated Systolic Blood Pressure ◽  
Cord Injury ◽  
Life Threatening

ABSTRACTPurposeAutonomic dysreflexia, often accompanied by heart rate changes, increases the risk of cardio-cerebrovascular complications in individuals with spinal cord injury. Thus, our aim was to characterize these changes during penile vibrostimulation and urodynamics.Materials and MethodsWe analyzed the cardiovascular (i.e. blood pressure and heart rate) data from two prospective studies, i.e. 21 individuals with chronic spinal cord injuries and history of autonomic dysreflexia, who underwent penile vibrostimulation (n=11, study 1) or urodynamics (n=10, study 2).ResultsThe cohort’s median age was 41 years (range 22 −53). Overall 47 episodes of autonomic dysreflexia were recorded (i.e. penile vibrostimulation n=37, urodynamics n=10), while at least one episode was recorded in each participant. At the threshold of autonomic dysreflexia, bradycardia was observed during penile vibrostimulation and urodynamics in 43% and 30% of all episodes, respectively. At the peak of autonomic dysreflexia during penile vibrostimulation and urodynamics, bradycardia was observed in 65% and 50%, respectively. In contrast, tachycardia was detected only once during urodynamics.ConclusionOur findings reveal that heart rate changes associated with autonomic dysreflexia during penile vibrostimulation and urodynamics appear to be related to the magnitude of systolic blood pressure increases. Thus, highly elevated systolic blood pressure associated with bradycardia suggest the presence of severe autonomic dysreflexia, which can lead to devastating cerebro-cardiovascular consequences. Therefore, we recommend cardiovascular monitoring during penile vibrostimulation and urodynamics to detect autonomic dysreflexia and stop assessments before systolic blood pressure is dangerously increasing, thereby reducing the risk of potentially life-threatening complications in this cohort.

Men’s Adjustment to Spinal Cord Injury: The Unique Contributions of Conformity to Masculine Gender Norms

2009 ◽  
Vol 4 (2) ◽  
pp. 157-166 ◽  
Author(s):  
Shaun Michael Burns ◽  
Sigmund Hough ◽  
Briana L. Boyd ◽  
Justin Hill
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Gender Norms ◽  
The United States ◽  
Future Research ◽  
Masculine Norms ◽  
Cord Injury ◽  
Future Research Directions ◽  
The Impact

Men constitute 82% of the approximately 250,000 people in the United States living with a spinal cord injury. Unfortunately, however, little is known about the impact of men’s adherence to gender norms on their adjustment to such injuries. The present investigation examined the utility of masculine norms in explaining variance in depression beyond that accounted for by commonly identified predictors of men’s adjustment following spinal cord injury. As hypothesized, results suggested that men’s adherence to masculine norms accounted for unique variance in their depression scores beyond that contributed by social support, environmental barriers/access, and erectile functioning. Respondents who adhered to norms stressing the primacy of men’s work demonstrated lower rates of depression, whereas those who conformed to norms for self-reliance demonstrated higher depression scores. The authors discuss future research directions and potential psychotherapeutic strategies for working with men with spinal cord injuries.

TENS attenuates response to colon distension in paraplegic and quadriplegic rats

2002 ◽  
Vol 283 (4) ◽  
pp. H1734-H1739 ◽  
Author(s):  
Heidi L. Collins ◽  
Stephen E. DiCarlo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Cervical Vertebra ◽  
Autonomic Dysreflexia ◽  
Thoracic Vertebrae ◽  
Hemodynamic Responses ◽  
Electrical Nerve Stimulation ◽  
Thoracic Level ◽  
Colon Distension ◽  
Life Threatening

Individuals with spinal cord injuries above thoracic level 6 experience episodic bouts of life-threatening hypertension as part of a condition termed autonomic dysreflexia (AD). The hypertension can be caused by stimulation of the skin, distension of the urinary bladder or colon, and/or muscle spasms. Transcutaneous electrical nerve stimulation (TENS) may reduce the severity of AD because TENS has been used to inhibit second-order neurons in the dorsal horn. Therefore, we tested the hypothesis that TENS attenuates the hemodynamic responses to colon distension. Eleven Wistar rats underwent spinal cord transection between thoracic vertebrae 4 and 5 (paraplegic, n = 6) or between cervical vertebra 7 and thoracic vertebra 1 (quadriplegic, n = 5). After recovery, all rats were instrumented with a radiotelemetry device for recording arterial pressure. Subsequently, the hemodynamic responses to graded colon distension were determined before and during TENS. During TENS the hemodynamic responses to colon distension were significantly attenuated. Thus TENS may be a preventive approach to reduce the severity of AD in paraplegic and quadriplegic individuals.

scholarly journals Most common arrhytmias in patients with spinal cord injury

2021 ◽  
Author(s):  
Gabriel Andreata Brandão ◽  
Vinícius Andreata Brandão ◽  
Lucas Dalvi Armond Rezende ◽  
Kelly Eduarda de Jesus Silva ◽  
Bruno Henrique Fiorin
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Injuries ◽  
Sinus Node ◽  
Clinical Manifestations ◽  
Autonomic Dysreflexia ◽  
Cardiac Conduction ◽  
Conduction Disorders ◽  
Cord Injury ◽  
Touch Sensitivity

Introduction: The spinal cord injury is a public heatlh problem, and it can have three different origens: traumatic, compressive and congenital. The consequences are partial or total insufficiency of the spinal cord due to the interruption of motor and sensory nervous tracts. This injury results in clinical manifestations such as: autonomic dysreflexia, conduction disorders and loss of pain and touch sensitivity. Objectives: To describe the main cardiac conduction disorders on patients with spinal cord injury trough the guiding question: “What are the most common arrhytmic disorders in patients with spinal cord injury?” Methods: A integrative review was made in the MEDLINE and LILACS databases combining the MeSH descriptors: ‘Arrhytmias, cardiac” and “Spinal cord injuries”. Furthermore, the inclusion criteria was articles produced in the past ten years that answer the guiding question. Results: After na analysis, 6 out of 15 articles were selected to compound this review. The main disorders founded were tachycardia, sinus node dysfunction, atrial and ventricular fibrillation and bradychardia, the most founded disorder. There was also descripted the possibility for these patients to envolve into a distributive choque. Conclusion: Bradycardia was the main arrhythmic impairment found in patients with spinal cord injury, followed by ventricular and atrial fibrillation and tachycardia, with the severity of bradyarrhythmias being associated with the level and severity of the spinal cord injury

scholarly journals Successful non-surgical management of pleuroparenchymal fistula following cervical intraspinal empyema

2018 ◽  
Vol 88 (1) ◽  
Author(s):  
Christopher Ull ◽  
Mirko Aach ◽  
Josef Reichert ◽  
Thomas Armin Schildhauer ◽  
Justyna Swol
Keyword(s):  
Spinal Cord ◽  
Surgical Management ◽  
Spinal Cord Injuries ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
Pulmonary Infections ◽  
Talc Pleurodesis ◽  
Lumen Tube ◽  
Cord Injury ◽  
Life Threatening

Pulmonary infections are life-threatening complications in patients with spinal cord injuries. In particular, paraplegic patients are at risk if they are ventilator-dependent. This case history refers to a spinal cord injury with a complete sensorimotor tetraplegia below C2 caused by a septic scattering of an intraspinal empyema at C2-C5 and T3-T4. A right-sided purulent pneumonia led to a complex lung infection with the formation of a pleuroparenchymal fistula. The manuscript describes successful, considerate, non-surgical management with shortterm separate lung ventilation. Treatment aimed to achieve the best possible result without additional harm. A variety of surgical and conservative strategies for the treatment of pleuroparenchymal fistula (PPF) have been described with different degrees of success. We detail the non-surgical management of a persistent PPF with temporary separate lung ventilation (SLV) via a double-lumen tube (DLT) in combination with talc pleurodesis as an approach in patients who are unable to undergo surgical treatment.

School Nurses on the Front Lines of Healthcare: Emergencies Associated With Sport and Physical Activities (Part 2): Sudden Cardiac Arrest, Hypovolemic Shock, and Spinal Cord Injury

2021 ◽  
pp. 1942602X2110460
Author(s):  
Thomas P. Swaffield ◽  
Robert P. Olympia
Keyword(s):  
Physical Activity ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cardiac Arrest ◽  
Sudden Cardiac Arrest ◽  
Hypovolemic Shock ◽  
The United States ◽  
Physical Activities ◽  
Cord Injury ◽  
Life Threatening

Sport participation is an important part of the development, both physically and mentally, of children and adolescents in the United States. Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life-threatening illnesses or injuries may occur. It is important for the school nurse to recognize potential life-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider’s office, or directly to the closest emergency department via Emergency Medical Services). This article specifically describes the initial assessment and management of three potentially life-threatening conditions associated with sport and physical activity, namely sudden cardiac arrest, hypovolemic shock, and spinal cord injury.

Role of Microglia and Astrocytes in Spinal Cord Injury Induced Neuropathic Pain

2021 ◽  
pp. 097275312110463
Author(s):  
Gurwattan S. Miranpuri ◽  
Parul Bali ◽  
Justyn Nguyen ◽  
Jason J Kim ◽  
Shweta Modgil ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neuropathic Pain ◽  
Spinal Cord Injuries ◽  
Medical Condition ◽  
The United States ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Cord Injury

Spinal cord injuries incite varying degrees of symptoms in patients, ranging from weakness and incoordination to paralysis. Common amongst spinal cord injury (SCI) patients, neuropathic pain (NP) is a debilitating medical condition. Unfortunately, there remain many clinical impediments in treating NP because there is a lack of understanding regarding the mechanisms behind SCI-induced NP (SCINP). Given that more than 450,000 people in the United States alone suffer from SCI, it is unsatisfactory that current treatments yield poor results in alleviating and treating NP. In this review, we briefly discussed the models of SCINP along with the mechanisms of NP progression. Further, current treatment modalities are herein explored for SCINP involving pharmacological interventions targeting glia cells and astrocytes. The studies presented in this review provide insight for new directions regarding SCINP alleviation. Given the severity and incapacitating effects of SCINP, it is imperative to study the pathways involved and find new therapeutic targets in coordination with stem cell research, and to develop a new gold-standard in SCINP treatment.

Development and Implementation of an Evidence-Based Guideline for Spinal Cord Injury/Disorder Patients Requiring Colonoscopy

2021 ◽  
Author(s):  
◽  
Tanya Young
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Bowel Preparation ◽  
Spinal Cord Injuries ◽  
The United States ◽  
Evidence Based ◽  
Usual Practice ◽  
Cord Injury ◽  
Bowel Prep ◽  
Evidence Based Guideline

Practice Problem: Colorectal cancer is one of the leading causes of preventable cancer death in the United States. Spinal cord injury/disorder (SCI/D) patients present with unique challenges for maximizing bowel prep and successful attainment of screening and therapeutic colonoscopy procedures. Current practice for bowel prep regimen does not take into consideration the specific needs of the SCI/D population resulting in significant patient dissatisfaction. PICOT: The PICOT question that guided this project was in adult patients with spinal cord injuries/disorders requiring colonoscopy (P), how does the development and implementation of evidence-based guideline for the care of the spinal cord injury/disorder patient requiring colonoscopy (I) compared to usual practice (C) affect the rate of first attempt successful colonoscopy procedure completion (O) within eight weeks (T). Evidence: SCI/D patients resulting neurogenic bowel increases difficulty with standard bowel prep tolerance. Quality bowel preparation is required for successful colonoscopy with inadequate bowel preparations present in 20-25% of all colonoscopies (Johnson et al., 2014). Evidence supports a clinical guideline for bowel preparation adapted to the needs of the SCI/D population. Intervention: Development and implementation of an SCI/D bowel prep guideline enhanced clinical decision support and evidence-based tools for improved bowel prep with initial attempt. Outcome: The rate of first-time colonoscopies for patients with SCI/D with the guideline improved by over 214% over pre-guideline time. Conclusion: The evidenced-based guideline reinforced clinical practice for the SCI/D population related to their unique requirements. Clinically significant improvement was noted in successful bowel prep completion, first attempt colonoscopy completion, improved access to the endoscopy suite, and reduced length of stay. All combined improved both patient and provider satisfaction with the evidence-based practice change.

scholarly journals Spinal Cord Injury in the Geriatric Population: Risk Factors, Treatment Options, and Long-Term Management

2017 ◽  
Vol 8 (2) ◽  
pp. 115-118 ◽  
Author(s):  
Tochukwu C. Ikpeze ◽  
Addisu Mesfin
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Treatment Options ◽  
Spinal Cord Ischemia ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
The United States ◽  
Cellular Damage ◽  
High Dose ◽  
Cord Injury

Spinal cord injuries (SCIs) are sustained by more than 12 500 patients per year in the United States and more globally. The SCIs disproportionately affect the elderly, especially men. Approximately 60% of these injuries are sustained traumatically through falls, but nontraumatic causes including infections, tumors, and medication-related epidural bleeding have also been documented. Preexisting conditions such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis can render the spine stiff and are risk factors as well as cervical spondylosis and ensuing cervical stenosis. Treatment options vary depending on the severity, location, and complexity of the injury. Surgical management has been growing in popularity over the years and remains an option as it helps reduce spinal cord compression and alleviate pain. Elevating mean arterial pressures to prevent spinal cord ischemia and avoiding the second hit of SCI have become more common as opposed to high dose steroids. Ongoing clinical trials with pharmacological agents such as minocycline and riluzole have shown early, promising results in their ability to reduce cellular damage and facilitate recovery. Though SCI can be life changing, the available treatment options have aimed to reduce pain and minimize complications and maintain quality of life alongside rehabilitative services.

Sign in / Sign up

Export Citation Format

Share Document