ABSTRACT
Autonomic dysreflexia is a syndrome of massive imbalance of reflex sympathetic discharge occurring in patients with spinal cord injury with a lesion above the splanchnic outflow (Thoracic 6). Autonomic dysreflexia is characterized by a sudden and severe rise in blood pressure and is potentially life threatening. Because the onset of this entity is rapid and the potential morbidity is severe, it is important for those caring for spinal cord injury patients to be aware of this syndrome. The paper presents a review of the literature, and familiarizes one with the diagnosis, pathophysiology, and treatment. Two illustrative case reports are also presented.
Subject(s)
Ankle/surgery , Autonomic Dysreflexia/etiology , Autonomic Dysreflexia/prevention & control , Foot/surgery , Spinal Cord Injuries/complications , Adult , Autonomic Dysreflexia/physiopathology , Clinical Protocols , Humans , Male , Perioperative CareABSTRACT
OBJECTIVE: To determine current characteristics of bowel care practices of chronic spinal cord injury (SCI) patients. DESIGN: Prospective interview and examination of 100 SCI patients injured for more than 1 year. SETTING: Freestanding rehabilitation outpatient SCI center. PARTICIPANTS: One hundred chronic SCI patients. RESULTS: The following bowel program characteristics were found: alternate-day programs were most common; most subjects performed their programs in the morning; and tetraplegic subjects performed their programs less often, used suppositories more often, required greater assistance, and took longer to complete their programs. CONCLUSIONS: Bowel dysfunction in chronic SCI need not be associated with complications in the majority of cases.
Subject(s)
Fecal Incontinence/rehabilitation , Self Care/methods , Spinal Cord Injuries/complications , Activities of Daily Living , Adolescent , Adult , Aged , Cathartics/therapeutic use , Chronic Disease , Constipation/etiology , Diarrhea/etiology , Fecal Incontinence/etiology , Female , Humans , Incidence , Male , Middle Aged , Prospective Studies , Surveys and Questionnaires , Time FactorsABSTRACT
This study was conducted to further investigate the natural history of the anemia, hypoproteinemia and hypoalbuminemia commonly observed in patients with traumatic spinal cord injury (SCI). Blood samples were taken from 46 traumatic SCI patients at the time of initial admission to an acute rehabilitation hospital and again approximately one year later during a routine follow-up appointment. At initial admission, 65 percent of patients were anemic (hemoglobin < 13.0 g/dl), 86.7 percent were hypoalbuminemic (albumin < 3.2 g/dl) and 48.9 percent were hypoproteinemic (total protein < 6.5 g/dl). Deficiencies were most commonly observed in tetraplegics and in patients with complete injuries. At the time of follow-up, 6.8 percent of patients were anemic, 2.2 percent demonstrated abnormally low serum protein concentrations and a significant (p = 0.01) decrease in the incidence of each deficiency was observed. Our findings suggest that anemia and decreased serum protein concentrations, while commonly observed in the acute SCI population, are much less frequently encountered in the more chronically injured. If noted in the chronic SCI patient, these deficiencies should alert clinicians to the likelihood of a concurrent process.
