Dysreflexia nke autonomic na mmerụ ahụ ọkpụkpụ azụ¶

Autonomic dysreflexia (AD), nke a na-akpọkwa hyperreflexia autonomic, bụ ihe mberede ahụike na-eyi ndụ egwu nke na-emetụta ndị nwere ọkpụkpụ azụ (SCI) na ma ọ bụ karịa nke isii thoracic vertebra (** T6 larịị na elu **, gụnyere niile cervical tetraplegia / quadriplegia na elu thoracic paraplegia). N'ịbụ onye ihe mkpali na-egbu mgbu ma ọ bụ na-akpasu iwe na-akpata n'okpuru ọkwa mmerụ ahụ, nke na-abụkarị ** eriri afọ zuru oke, catheter urinary kinked ma ọ bụ egbochiri, ma ọ bụ afọ ntachi obi siri ike **, eriri afọ nke ala na-eme ka mmetụta ọmịiko na-achịkwaghị achịkwa nke na-egbochi arịa ọbara afọ na ụkwụ. Ọbara mgbali elu na-erute n'ime nkeji nkeji site na 20 ruo 40 mmHg ma ọ bụ karịa n'elu ntọala dị ala nke onye ahụ (na-erute \(180\text{to }300\text{mmHg}\) systolic), na-ebute isi ọwụwa mberede na mberede, na-eme ka ọsụsọ dị elu karịa mmerụ ahụ, obi dị ize ndụ na-ebelata (bradycardia), ọrịa strok, hemorgic hemorgic hemorical infarction, na ọnwụ ma ọ bụrụ na onye ahụ na-adịghị ozugbo nọdụ ziri ezi na n'okpuru mkpalite ahụ efep.

Mee nke a ugbu a¶

1. Nọdụ ala onye ahụ kwụ ọtọ n'ogo ogo 90 wee dachie ụkwụ ya n'ala. Ọ bụrụ na onye ahụ dinara n'àkwà, welie isi ihe ndina ahụ ruo ogo 90 ma wetuo ụkwụ ya n'akụkụ akwa akwa ahụ; ọ bụrụ na ha nọ n'oche nkwagharị ike na-anọdụ ala, gbadaa oche ahụ n'ụzọ zuru oke ma wetuo ala ụkwụ. Ike ndọda na-ebute ịgbakọ ọbara orthostatic n'ime ahụ kpọnwụrụ akpọnwụ ma na-enye mbelata ọbara mgbali elu na-abụghị ọgwụ ngwa ngwa.
2. ** Tọpụ ma ọ bụ wepụsịa uwe niile siri ike, ihe nkedo, eriri na sọks mkpakọ.** Ozugbo ahụ, wepụ ihe mgbochi afọ, eriri obi, eriri siri ike, eriri akpụkpọ ụkwụ, eriri akpa ụkwụ, condom catheters, na uwe ogologo ọkpa, ma yipụ sọks na-agbanwe agbanwe (TED hose). Iwepu mkpakọ dị n'èzí na-agbasawanye ikike venous nke afọ na ụkwụ ma wepụ ihe na-akpata nrụgide anụ ahụ.
3. ** Lelee ọbara mgbali elu kwa nkeji 2 ruo 5 wee mata akara ala SCI dị ala.** Ọbara mgbali elu systolic nkịtị na onye nwere cervical ma ọ bụ elu thoracic tetraplegia/paraplegia na-adịkarị ala, nke na-abụkarị \(90\text{ to} 110\text{mmHg}\) na ndị okenye. N'ihi ya, ọgụgụ ọbara mgbali elu nke \(120/80 ederede{mmHg}\) ma ọ bụ \(130/85\text{mmHg}\) (nke na-ele anya "nkịtị" nye onye nọọsụ ma ọ bụ onye na-ahụ maka ahụike na-azụghị ọzụzụ) na-anọchi anya ihe dị ize ndụ ** $ 20 ederede { ka 40\text{mmHg}$ na-egosi hypertensive dysflex.
4. ** Nyochaa eriri afo na usoro urinary nke mbụ (na-akpata pasent 75 ruo 85 nke ikpe niile). Ọ bụrụ na ọ dịghị mmamịrị na-esi na catheter maka nkeji 2 ruo 3, jiri nwayọọ gbanye na ** 10 ruo 15 milliliters (0.3 ka 0.5 mmiri mmiri ounces)** nke ime ụlọ-okpomọkụ saline nkịtị ma ọ bụrụ na a zụrụ ya (ọ dịghị mgbe ọ bụla mmanye mmiri ma ọ bụ na-eji mmiri oyi), ma ọ bụ ** wepụ catheter egbochiri ma tinye cathetera n'ime ngwa ngwa ngwa ngwa. Ọ bụrụ na onye ahụ na-eme catheterization na-adịte aka, tinye eriri afọ ya ugbu a.
5. Lelee eriri afọ nke abụọ ma ọ bụrụ na eriri afọ ahụ tọgbọ chakoo, ọbara na-adịkwa elu (\(>150\text{mmHg}\) systolic) Mmetụta afọ (afọ ntachi) bụ ihe nke abụọ na-ebute autonomic dysreflexia. ** Kwụsị mmemme afọ ọ bụla na-arụ ọrụ ma ọ bụ ihe mkpali dijitalụ ozugbo.** Tupu iji mkpịsị aka aka aka elele ikensi, ọ bụrụ na mgbali elu dị ** na ma ọ bụ karịa \(150\text{mmHg}\) systolic**, kpọọ nọmba mberede mpaghara gị (911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom niile, ma ọ bụ hụ na United Kingdom niile, nọmba mberede) ma na-enye onye ọrịa ọgwụ ọgwụ na-eme ngwa ngwa nke ọnụ ma ọ bụ ọgwụ mgbochi hypertensive (dịka sublingual/chewed nifedipine, captopril, ma ọ bụ nitroglycerin paste, ** naanị mgbe ekwenyeghị na ọ dịghị sildenafil/Viagra iji**). Chere nkeji 5 ka ịtinye 2% lidocaine anesthetic gel n'ime ikenahụ tupu ewepụtụ stool ọ bụla iji zere ime ka mmeghachi omume ahụ ka njọ.
6. ** Lelee akpụkpọ ahụ na nsọtụ nke atọ, wee kpọọ 911/112/999 ma ọ bụrụ na mgbaàmà na-adịgide ma ọ bụ BP na-anọ \(\ge 150\text{mmHg}\).* mbọku gbajiri agbaji; ọnya mgbali elu (bedsores); ntachu ma ọ bụ ọkụ ọkụ; mgbaji ọkpụkpụ zoro ezo; ma ọ bụ mgbakasị ịhụ nsọ/arụ ọrụ. Kpọọ ndị ọrụ ahụike mberede ozugbo ma ọ bụrụ na ịnweghị ike ịhụ ihe na-akpalite ya, ọ bụrụ na ọbara mgbali elu systolic na-anọ na ma ọ bụ karịa \(150\text{mmHg}\), ma ọ bụ ọ bụrụ na isi ọwụwa na-ada ụda siri ike, ọhụụ na-agbanwe, mgbu obi, ma ọ bụ mgbagwoju anya na-aga n'ihu.

Autonomic dysreflexia nke ụlọ ọgwụ na eserese usoro mkpebi nzọụkwụ¶

Soro Paralyzed Veterans of America (PVA) na International Spinal Cord Society (ISCoS) ọgwụ algọridim n'usoro kpọmkwem site n'elu ruo na ala.

flowchart TD
    Start["Onye nwere Ọkpụkpụ Ọkpụkpụ Ọkpụkpụ na T6 ma ọ bụ N'elu Na-etolite: <br/> Na-akpata isi ọwụwa, ọsụsọ / na-efe efe n'elu mmerụ ahụ, <br/> Goosebumps/Akpụkpọ anụ oyi na-acha n'okpuru mmerụ ahụ, ma ọ bụ ihe imi imi."] --> Step1SitUp["NKWUKWU 1: MGBE ỌZỌ NA-EKWESỊRỊ & MMADỤ ỤWA<br/>1. Nọdụ ala onye kwụ ọtọ na 90 degrees; ụkwụ ala gbadaa<br/>2. Tọpụ eriri niile, eriri afọ, eriri ụkwụ, na uwe siri ike<br/>3. Wepu sọks mkpakọ (TED hose) <br/>4. Lelee mgbali ọbara kwa nkeji 2 ruo 5 (AD = ịrị elu> = 20 mmHg n'elu ntọala)"]

    Step1SitUp --> Step2Bladder{"Nzọụkwụ 2: Nyochaa eriri afọ mbụ (85% nke ikpe)<br/>Onye ọrịa ọ nwere ebe obibi<br/>Foley ma ọ bụ suprapubic catheter?"}

    Step2Bladder -->|"Enweghị catheter dị n'ime"| IntermittentCath["Mee catheterization na-adịte aka ozugbo: <br/> Tinye 2% Lidocaine anesthetic gel n'ime urethra mbụ (chere 2 mins) <br/> Wepu eriri afọ kpamkpam; nyochaa BP maka ọdịda mberede"]

    Step2Bladder -->|"Ee: Kateta obibi dị ugbu a"| CheckTubing{"A na-akụ ọkpọkọ, kpọchie,<br/>ma ọ bụ akpa juputara?"}
    CheckTubing -->|"Ee: Kinked ma ọ bụ juputara"| UnkinkBag["tubing na-adịghị, oghere mepere emepe, akpa ala dị n'okpuru ọkwa nke eriri afo,<br/>na akpa nnakọta efu. Lelee BP n'ime nkeji 5 na-abịa."]
    CheckTubing -->|"Mba: tubing kwụ ọtọ, mana gbochiri/enweghị mgbaba"| ReplaceFoley["AKWỤKWỌ mmiri dị ukwuu n'ime eriri afọ egbochiri.<br/>Wepu catheter egbochiri wee fanye catheter ọhụrụ site na iji 2% Lidocaine gel<br/>(Nhọrọ dị nro 10 ruo 15 mL room-temp saline flush ONLY ma ọ bụrụ na a zụrụ ya)"]

    IntermittentCath --> BPCheckAfterBladder{"Systolic BP dara n'okpuru<br/>150 mmHg na isi ọwụwa kwụsịrị?"}
    UnkinkBag --> BPCheckAfterBladder
    ReplaceFoley --> BPCheckAfterBladder

    BPCheckAfterBladder -->|"Ee: Ekpebiri"| Monitor2Hrs["Gaa n'ihu nyochaa BP na mgbaàmà ọ bụla 15 ruo 30 mins maka awa 2."]

    BPCheckAfterBladder -->|"Mba: BP ka na-ebuli elu"| Step3BPThreshold{"Nzọụkwụ 3: Lelee SYSTOLIC BP tupu ịlele afọ afọ<br/>Systolic BP>= 150 mmHg (Ndị okenye)?"}

    Step3BPThreshold -->|"Ee: Systolic BP>= 150 mmHg"| MedAndEMS["1. Kpọọ 911 / 112 / 999 ozugbo <br/>2. Nye onye ọrịa ọgwụ ọgwụ na-amalite ngwa ngwa antihypertensive<br/> (dịka, Captopril 25 mg, Nifedipine 10 mg, or 2% Nitroglycerin paste<br/> Naanị mgbe ị chọpụtachara NO Sildenafil/Tadalafil PDE5 inhibitor ojiji) <br/>3. Tinye 2% Lidocaine rectal gel ma chere nkeji 5 tupu ịlele eriri afọ"]

    Step3BPThreshold -->|"Mba: Systolic BP <150 mmHg"| Step4Bowel["Nzọụkwụ 4: Lelee afọ ntachi maka mmetụta FECAL<br/>1. Tinye 2% Lidocaine anestetiiki gel n'ime ikensi ike<br/>2. Chere nkeji 5 maka mbelata ike ike<br/>3. Jiri nwayọ lelee ikensi na mkpịsị aka gloved mmanụ ma wepụ stool <br/> (Kwụsị ozugbo ma ọ bụrụ na BP gbagoro elu n'oge nlele dijitalụ)"]

    MedAndEMS --> Step4Bowel
    Step4Bowel --> Step5Skin["Nzọụkwụ 5: Lelee akpụkpọ ahụ, mbọ, na ihe ndị ọzọ na-akpali akpali n'okpuru mmerụ ahụ<br/> Nyochaa ihe siri ike n'okpuru buttocks, nsogbu ọnya, mbọ mkpịsị ụkwụ gbajiri,<br/>akpụkpọ ụkwụ siri ike, ọkụ, mgbaji, UTI, ma ọ bụ ọrụ.<br/>Transport to Emergency Department or 5 if ADH."]

Pathophysiology: Gịnị kpatara T6 ji bụrụ ahịrị nkewa ahụ dị oke egwu¶

Ịghọta ihe kpatara dysreflexia autonomic ji eme naanị na ọnya ọkpụkpụ azụ na ma ọ bụ karịa ** T6 (nke isii thoracic) akụkụ spinal ** (na mgbe ụfọdụ T7 ruo T8) na-eme ka usoro ọ bụla nke usoro mberede ahụ bụrụ ihe ezi uche dị na ya.

1. ** Ihe mkpali na-egbu mgbu ma ọ bụ nke na-egbu mgbu na-apụta n'okpuru mmerụ ahụ nke ọkpụkpụ azụ **: N'agbanyeghị na onye ahụ enweghị ike ịma ihe mgbu site na eriri afọ gbawara agbawa ma ọ bụ ntu mkpịsị ụkwụ nke dị n'okpuru ọnya azụ ha, ihe mgbu na-adịghị ahụkebe na gbatịa akwara site na eriri afo, bowel, ma ọ bụ akpụkpọ anụ ka na-ebu mgbama mkpagbu ngwa ngwa n'ime eriri afọ nke ala.
2. ** Nnukwu mpụta ọmịiko splanchnic (T5 ruo L2): Ozugbo mgbaàmà nhụjuanya na-abanye n'ọkpụkpụ azụ n'okpuru mmerụ ahụ, ọ na-aga elu ruo mgbe ọ na-adaba n'ọkpụkpụ azụ / transection. Enweghị ike ịfefe ụbụrụ nke ọma, mgbama ahụ na-ebute nnukwu mmetụta ọmịiko na-adịghị egbochi ya n'ofe thoracolumbar ọmịiko (T5 site L2). N'ụzọ dị oke mkpa, ** akwara splanchnic ka ukwuu na-apụta site na T5 ruo T9 ** ma na-achịkwa ** splanchnic vaskụla bed ** (nnukwu netwọk nke arịa ọbara na afọ, eriri afọ, imeju, splin, na akụrụ nke na-ejide ihe dị ka ** 25 ruo 30 pasent nke ọnụ ọgụgụ ọbara zuru oke nke ahụ mmadụ **).
3. ** Gịnị kpatara T6 na n'elu na-emepụta nsogbu ọbara mgbali elu na-agba ọsọ ***: Mgbe ọnya ahụ dị na ** T6 ma ọ bụ karịa **, ụbụrụ na-agbadata calming (inhibitory) mgbaàmà enweghị ike ịgafe mmerụ ahụ nke ọkpụkpụ azụ iji ruo T5 ruo T9 akwara splanchnic. Ọkpụkpụ ọbara splanchnic na akwara anụ ahụ dị ala na-amagide ike, na-amanye ihe karịrị otu lita ọbara elu n'ime igbe, olu, na ụbụrụ n'ime sekọnd ma na-ebuli ọbara mgbali systolic site na \(40\text{ ruo }150+\text{ mmHg}\). (N'ụzọ dị iche, ọ bụrụ na mmerụ ahụ mmadụ dị na T10 ma ọ bụ L1, ụbụrụ ha na-ejigide ihe dị n'elu T5 ruo T9 splanchnic bed ma nwee ike gbasaa arịa afọ iji gbochie ọbara mgbali elu).
4. ** Paradox ahụ gbawara agbawa (Vasoconstriction N'okpuru, Vasodilation na Bradycardia N'elu) ***:
5. Above the injury: Carotid sinus and aortic arch baroreceptors sense the dangerous blood pressure spike and alert the brainstem. The brainstem sends two emergency signals: first, it fires the vagus nerve (Cranial Nerve X), which travels outside the spinal cord directly to the heart to slow the heart rate down (reflex bradycardia, often \(40\text{ to }55\text{ beats per minute}\), though some patients show tachycardia or arrhythmias); second, it dilates blood vessels and activates sweat glands in the intact spinal segments above the level of the injury, causing a throbbing vascular headache, bright red flushed face and neck, profuse forehead/shoulder sweating, and nasal congestion.
6. Below the injury: Because the brainstem's calming signals are blocked at the spinal cord lesion, the lower body remains locked in extreme sympathetic vasoconstriction, appearing pale, cold, clammy, and covered in goosebumps (piloerection).

Recognizing autonomic dysreflexia: Baseline blood pressure vs. crisis numbers¶

One of the deadliest medical errors in emergency rooms occurs when a triage nurse or paramedic measures a quadriplegic patient's blood pressure at \(135/85\text{ mmHg}\), declares "Your blood pressure is completely normal," and ignores a life-threatening autonomic dysreflexia crisis.

Because people with cervical or high thoracic spinal cord injuries lack baseline sympathetic vascular tone, their normal resting blood pressure is neurogenically hypotensive. Use this reference table to interpret blood pressure accurately by age group (based on the Consortium for Spinal Cord Medicine / Paralyzed Veterans of America guidelines):

Ihe ịrịba ama na akara ngosi kpochapụ n'elu na n'okpuru ọkwa nke mmerụ ahụ¶

• ** Na mberede, isi ọwụwa na-ama jijiji (bifrontal ma ọ bụ occipital)**: Ọ dị ka jackhammer n'ime okpokoro isi ka akwara ụbụrụ na-agbatị n'okpuru nrụgide dị elu.
• **Ọsụsọ na-agbasi ike (diaphoresis) karịa ọkwa mmerụ ahụ **: Ọsụsọ na-agbada n'egedege ihu, ihu, olu na ubu elu ebe ahụ dị ala na-anọ n'ọkpụkpụ.
• ** Akpụkpọ ahụ na-acha uhie uhie na-acha uhie uhie (erythema) karịa ọkwa mmerụ ahụ ***: patches na-acha uhie uhie na-egbuke egbuke n'ihu, olu, na elu obi.
• ** Oyi, icha mmirimmiri, akpụkpọ ahụ na-adịghị mma na goosebumps (cutis anserina / piloerection) n'okpuru ọkwa mmerụ ahụ ** (na mgbe ụfọdụ gafee ogwe aka na nnukwu mmerụ ahụ nke cervical).
• Mkpọchị imi na mberede (imi juru): Ihe kpatara ya bụ vasodilation parasympathetic nke mucosa imi.
• ** ọgba aghara a na-ahụ anya ***: ọhụụ na-agbagwoju anya, ịhụ ntụpọ (scotomata), ma ọ bụ nghọta na ìhè.
• ** Mgbaàmà nke obi ***: Ọkụ na-akụ nwayọ nwayọ, dị arọ n'olu (bradycardia n'okpuru 60 iti kwa nkeji) ma ọ bụ nkụchi obi na-adịghị na mberede, njigide obi, na oke ụjọ ma ọ bụ mmetụta nke mbibi na-abịa.
• Dysreflexia "Silent" Autonomic Dysreflexia ***: Ruo ** pasent 30 ruo 40 nke nrịbama ọbara edere ede n'oge ule urodynamic ma ọ bụ nlekọta afọ afọ na-eme na obere isi ọwụwa ma ọ bụ efu **, nke pụtara na ndị na-elekọta ya kwesịrị ịlele ọbara mgbali elu mgbe ọ bụla onye ọrịa gosipụtara nhịahụ ihu na-enweghị nkọwa, ọsụsọ, ma ọ bụ ụbara spasms muscle (spasticity).

Ndepụta nyocha zuru oke nke autonomic dysreflexia na-akpalite (3 Bs: eriri afo, eriri afọ, ahụ)¶

Mgbe ị na-achọ ihe kpatara ihe kpatara dysreflexia autonomic, ** achọla ya na enweghị usoro *. Na-arụ ọrụ n'usoro site na ** eriri afọ (75% ruo 85% nke ikpe niile), wee bowel (10% ruo 15% nke ikpe)**, na n'ikpeazụ ** Sn / Ahụ (5% ruo 10% nke ikpe)**.

Nchọpụta nsogbu nke catheter urinary zuru ezu na-eme ka nsogbu ahụ ka njọ¶

N'ihi na ihe dị ka 4 n'ime 5 autonomic dysreflexia episodes na-esi na eriri afọ, ịmara ihe ** na-adịghị ** ime na catheter urinary dị nnọọ mkpa dị ka ịmara ihe ị ga-eme:

1. Ejila ike ịgba mmiri ma ọ bụ sirinji mee ihe karịrị milliliters 10 ruo 15 (0.3 ruo 0.5 mmiri mmiri ounces) n'ime eriri afọ gbawara agbawa ***: Ọ bụrụ na eriri afọ onye ọrịa ejirila 600 milliliters nke mmamịrị tọrọ atọ na ị na-amanye 50 milliliters saline site na eriri Foley egbochiri, ị na-agbatịkwu mgbidi ahụ n'ime eriri afọ ahụ. nrụgide. Ọ bụrụ na mmiri dị n'ime ụlọ 10 ruo 15 milliliter na-ekpo ọkụ na-ekpo ọkụ nke saline nkịtị anaghị eweghachi ngwa ngwa drainage n'efu, ** kwụsị ịsa mmiri, kpochapu balloon, wepụ catheter egbochiri, ma tinye catheter ọhụrụ.
2. ** Na-eji saline-okpomọkụ (ma ọ bụ okpomoku-okpomọkụ ahụ) mgbe niile, mmiri anaghị ajụ oyi ***: Mmiri oyi na-emetụ eriri afo urothelium na-akpali C-fibers oyi na-anabata ma nwee ike ịkpalite ma ọ bụ mee ka autonomic dysreflexia ka njọ.
3. ** Tinye intra-urethral 2% lidocaine (lignocaine) gel anestetiiki tupu catheterizing ***: Tupu ịtinye onye na-anọchi Foley catheter ma ọ bụ catheter intermittent n'oge ọgba aghara AD na-arụ ọrụ, gbanye 5 ruo 10 milliliters nke sterile ** 2% lidocaine hydrochloride jelii ** n'ime urethra wee chere nkeji 2 ma ọ bụrụ na ọ ga-ekwe omume. Ihe anestetiiki mpaghara na-eme ka sphincter uretral na-egbochi ma na-egbochi ọrụ nke ịfefe catheter ka ọ ghara ịkpata mmụba ọbara nke abụọ.
4. ** Lezienụ anya maka hypotension post-decompression na hematuria ***: Ozugbo eriri afọ gbawara agbawa nke ukwuu gbapụrụ, vasoconstriction reflex na-akwụsị na mberede. Ejikọtara ya na onye ọrịa nọ ọdụ kwụ ọtọ na ogo 90 (ma ọ bụrụ na ha ewerekwa ọgwụ mgbali elu), ọbara mgbali elu nwere ike ịdaba na mberede n'okpuru \(70/40\text{mmHg}\), na-akpata isi ọwụwa ma ọ bụ nkụda mmụọ. Ozugbo mmamịrị na-asọpụta nke ọma na ọbara mgbali systolic na-adaghachi azụ n'usoro mmalite nke onye ọrịa (\(90\text{ to }110\text{mmHg}\)), ị nwere ike ịdabere azụ azụ ntakịrị ruo ogo 30 ma ọ bụ 45 ka ị na-enyocha ọbara mgbali kwa nkeji 10 ruo 15 ọ dịkarịa ala awa 2.

Emergency pharmacological management when blood pressure reaches 150 mmHg¶

Ọ bụrụ na ịnọdụ ọdụ onye ọrịa ahụ kwụ ọtọ, ịtọpụ uwe, na ịgbapu eriri afọ anaghị ebute ọbara mgbali systolic n'okpuru \(150\text{mmHg}\), ma ọ bụ ọ bụrụ na ọbara mgbali systolic bụ \(150\text{mmHg}\) ma ọ bụ karịa tupu ị nwaa imebi eriri afọ afọ ntachi, ntuziaka ụlọ ọgwụ maka Spinal Cord na Consortid Society. na-enye ** mmalite ngwa ngwa, onye na-ahụ maka ọgwụ mgbochi hypertensive na-adị mkpụmkpụ ** nke enyere onye ọrịa iwu maka ngwa AD ụlọ ha, ebe ọ na-akpọ ndị ọrụ ahụike mberede:

• ** Topical 2% Nitroglycerin Ude (Nitro Paste): A na-etinyekarị ya dị ka eriri ** 2.5 ruo 5 centimita (1 ruo 2 inch) n'akpụkpọ ahụ ** n'elu ọkwa mmerụ ahụ nke azụ azụ (dị ka igbe elu ma ọ bụ ọkpọiso, ebe arịa ọbara anaghị agbakọ). Isi uru nchekwa ya maka ndị na-elekọta ụlọ bụ na ** ngwa ngwa eriri afọ ma ọ bụ eriri afọ na-akpali akpali na ọbara mgbali na-amalite ịdaba, ị nwere ike iji anụ ahụ na ncha / mmiri hichapụ nitroglycerin mado n'ahụ ahụ ozugbo iji kwụsị ịmịnye ọgwụ ọzọ wee gbochie hypotension rebound. * (Akwụsịghị ya ma ọ bụrụ na ejiri sildenafil / vardenafil mee ihe n'ime awa 24 ma ọ bụ tadalafil n'ime awa 48).
• Oral Captopril: A na-edokarị \(25\text{ milligrams}\) nke etinyere n'okpuru ire (sublingually) ma ọ bụ tachaa na ilo. Captopril bụ ihe mgbochi ACE nke na-amalite ibelata ọbara mgbali n'ime nkeji 15 ruo 30 na-enweghị mgbochi PDE5 inhibitor nitrates, na-eme ka ọ bụrụ nhọrọ nke mbụ n'ọtụtụ ebe North America na European spinal center.
• Ntọhapụ ngwa ngwa Nifedipine: A na-eji akụkọ ihe mere eme eme dị ka \(10\text{ milligrams}\) capsule bitten wee loda (mara: ọtụtụ ụkpụrụ nke ọgbara ọhụrụ na-ahọrọ captopril ma ọ bụ nitrates topal na mbụ n'ihi na mwepụta nifedipine ozugbo nwere ike ime ka ọbara mgbali elu na-adịghị agbanwe agbanwe na-agbadata mgbe eriri afọ ahụ na-agbapụta ya).

Nkwado ya na ndị ọrụ ahụike na ndị ọrụ ime ụlọ mberede: Kaadị AD Wallet¶

N'ihi na autonomic dysreflexia pụrụ iche na ọnya ọnya ọnya n'elu T6, izugbe paramedics na mberede ụlọ ọrụ triage ndị na-adịghị ọkachamara na neurotrauma na-emekarị ugboro atọ dị ize ndụ emehie: 1. Ha na-anwa ịtọba onye ọrịa ahụ n'ala n'elu ebe ambulansị (nke na-ebute ọbara mgbali ụbụrụ). 2. Ha na-ahụ ọbara mgbali elu nke \(135/85\text{mmHg}\) ma na-ewepụ isi ọwụwa nke onye ọrịa dị ka "migraine" n'ihi na ha amaghị na ọbara mgbali elu nke onye ọrịa tetraplegic bụ \(90/60\text{mmHg}\). 3. Ha na-enye ọgwụ antihypertensive nke na-eme ogologo oge na-ebughị ụzọ lelee catheter egbochiri ma ọ bụ eriri afọ emetụtara, na-akpata ọtụtụ awa nke hypotension siri ike ozugbo emechiri catheter.

Every person with an SCI at T6 or above should carry a laminated Autonomic Dysreflexia Medical Alert Wallet Card (available from the Christopher & Dana Reeve Foundation, Paralyzed Veterans of America, Spinal Injuries Association UK, and Spinal Cord Injury Canada) clipped to their wheelchair bag and stored on their phone lock screen, and caregivers should hand it directly to the lead paramedic and triage physician.

Ajụjụ a na-ajụkarị¶

enyochara isi mmalite¶

• Consortium for Spinal Cord Medicine and Paralyzed Veterans of America (PVA, United States): Clinical Practice Guideline: Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions: Preventing the Highs and Lows (2020/2021 edition).
• International Spinal Cord Society (ISCoS) and American Spinal Injury Association (ASIA): International Standards to Document Autonomic Function Following Spinal Cord Injury (ISAFSCI) and acute emergency management protocols.
• National Health Service (NHS, United Kingdom), Spinal Injuries Association (SIA, United Kingdom), and Royal College of Physicians (United Kingdom): Chronic Spinal Cord Injury: Management of Patients in Acute Hospital Settings and Emergency Treatment of Autonomic Dysreflexia.
• Christopher & Dana Reeve Foundation Paralysis Resource Center (United States) and Spinal Cord Injury Model Systems (SCIMS, United States): Autonomic Dysreflexia Consumer and Emergency Medical Services (EMS) Wallet Card Guidelines.

Ntuziaka emetụtara¶

• Spinal injuries: neck and back stabilization
• Stroke recognition (FAST) and emergency response
• Seizures first aid and management
• Nkwarụ na mkpa ahụike atụmatụ mberede
• Nọmba mberede na izipu mba ofesi