Pocket Anesthesia (Pocket Notebook) by Urman Richard D

Author:Urman, Richard D. [Urman, Richard D.]
Language: eng
Format: epub
ISBN: 9781469813585
Publisher: Lippincot (Wolters Kluwer Health)
Published: 2012-09-05T00:00:00+00:00

Spinal Shock

• Disruption of all cord function caudal to spinal cord injury

• Causes flaccid weakness/lack of spinal arc reflexes at and below injury

Autonomic Hyperreflexia

• Most common in injuries above T6, occurs weeks to months after the acute injury

• Results from loss of descending inhibitory impulses + sympathetic system overactivity

• Stimulation below injury level (bladder distention, surgical stimulation) causes:

• Vasoconstriction/hypertension below injury

• Reflex bradycardia & dysrhythmias

• Vasodilation above injury

• Symptoms: Headaches, blurred vision, seizures, cerebral hemorrhage, pulmonary edema 2° to left heart failure, loss of consciousness, nasal congestion, cutaneous flushing

• Treatment:

• Remove stimulus

• Consider atropine for severe bradycardia

• Hypertension treated with direct vasodilators (nitroprusside/nitroglycerin), α-blockers (prazosin), ganglionic blockers (trimethephan)

• Consider using general anesthesia or spinal; epidural may not be as effective because of sacral sparing effect

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