Autonomic Dysreflexia (AD) NHS Alert
Posted by: The personal injury help and advice team
Making prominent news in the medical world, NHS England has just released a Patient Safety Alert on Autonomic Dysreflexia (AD), a condition which mainly affects those with spinal cord injuries and neurological disorders – frequently referred to as life-threatening.
The alert has been issued following raised concerns on spinal injury patients facing delays in receiving specialist care. As well as issuing an alert, the NHS has updated their publication regarding continence care and provided links to a range of resources to support this.
AD is a condition which is considered as not well recognised or understood by many professionals which increases the risk of poor outcomes. With this news crucially highlighted, Sian Rodger, a specialist nurse at the London Spinal Cord Injury Centre wrote a related piece in the Nursing Times this month:
“Providing appropriate care to patients with a spinal cord injury when they are unwell is essential to prevent complications that could impact recovery and life post-discharge.”
Such complications include Autonomic Dysreflexia, which involves a rapid rise in blood pressure often associated with poor bowel care or non-adherence to the normal routine. Without fast and effective action, AD can lead to further problems such as strokes.
Autonomic Dysreflexia refers to the over-activity of the autonomic nervous system (ANS). This is the unconscious part of the nervous system which regulates functions such as breathing, heart rate and digestion.
Usually related to the bladder or bowel, Autonomic Dysreflexia is triggered by an irritant below the level of injury; this can include urinary tract infections, constipation, haemorrhoids, blocked catheters and overfilled collection bags. As well as these causes, something as minor as cuts, bruises, and burns (including sunburn) can also be affecting factors. Further triggers include menstrual cramps, pregnancy and sexual intercourse.
Suspected causes should always be identified and removed if possible, but medications such as nitroglycerine paste can be applied above the level of injury. A stimulus below the injury level, which cannot be felt for spinal cord injury patients, sends nerve impulses up the spinal cord that become blocked at the place of injury – therefore they cannot reach the brain. Because of this, the reflex action increases activity of the sympathetic part of the ANS, resulting in narrowing blood vessels and a rise in blood pressure. Below the injury, blood pressure cannot be regulated by the brain.
Signs of AD vary for each individual, but can include high blood pressure, a slow pulse (below 60 beats per minute), nausea, a pounding headache, flushed face, nasal stuffiness, sweating above the place of injury and goose bumps below the place of injury.
David Sears at Minster law advises:
“It is important if you are at risk of suffering AD that you are aware of potential causes and symptoms and that your carers and other professionals properly understand the condition in order to maintain your wellbeing.
“The NHS has required all providers of NHS funded inpatient and community healthcare to identify an appropriate clinic lead, use the resources available, review educational and training provision for interventional bowel management and develop an action plan to ensure adequate and timely access to appropriately trained staff as well as reviewing local guidance.”