Autonomic Dysreflexia (AD) Autonomic dysreflexia is a dangerous syndrome that can occur in people with SCI at or above the T6 level (upper back). It involves a sudden surge in blood pressure due to an irritation or pain below the injury. Because the brain’s signals can’t get past the spinal injury, something as simple as a full bladder, tight clothing, or a pressure sore can trigger an uncontrolled reflex of the autonomic nervous system. AD signs include a pounding headache, flushed face, sweaty skin above the injury, vision changes, and a slow heart rate. Why it matters: Autonomic dysreflexia is a medical emergency. If not treated, extremely high blood pressure can lead to a stroke or seizure. Family members should learn to recognise AD, sit the person up, loosen tight clothing, and seek urgent medical help. Common triggers are a blocked urinary catheter, an overfull bladder or bowel, pressure ulcers, or other pain below the injury. Medical staff will educate you on managing and preventing AD once your loved one is stable. Neurogenic Shock This term refers to a specific kind of life- threatening shock that often occurs in the acute phase of a severe SCI, especially with high-level injuries. In neurogenic shock, the injury disrupts the autonomic nervous system, leading to dangerously low blood pressure and slow heart rate. The body loses the ability to regulate blood pressure, heart rate, and temperature. Neurogenic shock typically happens soon after the injury (often within minutes to hours). It is why someone with a cervical SCI might have very low blood pressure in the intensive care unit.
It requires immediate treatment (such as IV fluids, medications to raise blood pressure, and sometimes a pacemaker for the heart). Note: Neurogenic shock is different from “spinal shock,” which is a temporary flaccid paralysis and loss of reflexes after an acute SCI. The medical team will manage neurogenic shock in the ICU with close monitoring. Spinal Shock Not to be confused with neurogenic shock, spinal shock is a temporary state after an acute SCI where reflexes below the injury level stop and muscles are completely limp. It can last days to weeks. During spinal shock, it’s hard to assess the true level of injury because there may be no reflexes or muscle tone even in areas that aren’t permanently damaged. As spinal shock wears off, reflexes return (often spasticity begins). This is why doctors might wait a few days or weeks to give a firm prognosis – they need to see what function returns after the spinal shock phase. Pressure Sores / Pressure Ulcers These sores occur on the skin over bony areas due to prolonged pressure and lack of sensation. They are a major concern in paralysis because the person can’t feel pain from prolonged pressure. Common sites include the heels, tailbone, hips, and shoulder blades. Without good skin care (regular turning, specialised cushions, keeping skin clean and dry), pressure ulcers can develop and lead to serious infections. We mention this here because you may hear nurses talk about “preventing pressure sores” from day one – it’s a critical daily care issue.
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MEDICAL TERMS AND PROCEDURES
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