Automatic Disrespectia


Did you ever want to be a doctor but were not sure you would survive med school? What if I told you that I could acquaint you with a term that 98% of med school graduates either did not learn or have forgotten. It is a very technical term, but one which you can master the pronunciation of on the first try. Are you ready? Here it is. Automatic Disrespectia. What? Okay, not really. It is autonomic dysreflexia. (AD) The former is what you get from your resident teenager, and knowledge of the latter can save someone's life. AD is a potentially life-threatening condition which requires immediate medical attention, yet I am simply amazed at how many medical professionals are not aware of it. The lack of knowledge in the medical community is so widespread that rehab facilities equip patients with multiple cards about this topic to carry in wallets, have on bedsides etc. They warn you to be your own advocate, as most doctors will not be familiar with this condition. We thought they were kidding, but the first time we mentioned it in an emergency room, we were met with a blank look. Out came the card, which they kept! A condition most often associated with individuals who have spinal cord injuries at the T6 level or higher, AD is a reaction of the autonomic (involuntary) nervous system to excess stimulation. That is not the same as spending three hours at your mother-in-law's house. When an irritating stimulus (ingrown toenail, blunt trauma, blocked catheter etc.) is introduced below the level of spinal cord injury, nerve impulses are sent to the spinal cord where they travel upward until they are blocked at the point of spinal cord injury. Since these impulses cannot reach the brain, a reflex is activated that results in spasms and a narrowing of blood vessels. It is characterized by sudden and severe high blood pressure, and the potential for throbbing headaches, profuse sweating, nasal stuffiness, and flushing of the skin above the level of spinal cord injury. While this may sound like what happens whenever you see your daughter's boyfriend, the prognosis and treatment is much different. Finding the source of the problem is critical in order to prevent a heart attack, stroke or death. AD can be easily treated as well as prevented. The key is knowing your baseline blood pressure, triggers, and symptoms. If AD is suspected, the first thing to do is sit up and raise the head to 90°. If you can lower your legs, do so. Next, loosen or remove any constrictive clothing, and be sure to check your blood pressure every five minutes. A blood pressure reading of 20-40 millimeters of mercury above baseline in adults (15-20 in adolescents) may be a sign of autonomic dysreflexia. If you do suspect it, locate and remove the offending stimulus as quickly as possible. In order of priority, look for bladder and bowel issues followed by tight clothing and skin issues. As you remove the stimulus, be aware that AD may get worse before it gets better. What about medicines? Generally speaking, medications are used only if the cause cannot be identified or removed, or when an episode of AD persists even after the suspected cause has been alleviated. Simply being aware of autonomic dysreflexia and its symptoms put you one step ahead of many medical professionals, and virtually the entire general population. In my book however, it also earns you my automatic respectia!

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