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Thursday 8 February 2018



  • fatal emergency unique to spinal cord injured patient
  • a/c,massive, disordered autonomic (sympathetic) response to specific stimuli in patients with spinal cord injury above T6 -8 level (sympathetic outflow)
  • chance of occurrence
    • cervical cord injury 60%
    • thoracic cord injury 20%
  • stimuli can be
    • bladder / bowel distension (MC)
    • skin stimuli (pressure ulcer/sun burn)
    • other causes (menstrual clamps, labor, sexual stimuli etc.)
    • lower urinary tract instrumentation, catheter change, catheter obstruction
    • clot retention
  • condition resolves quickly if stimulus with drawn
  • stimuli carried by intact peripheral sensory nerves to spinal cord
  • this stimulates sympathetic plexus
  • leads to peripheral vasoconstriction – BP increases
  • baroreceptors respond to increased BP – sends message to brain stem
  • brainstem in turn stimulates vagus – decreased heart rate and inhibit sympathetic message via spinal cord
  • inhibitory message can not reach sympathetic system as cord is injured – BP remains elevated


Clinical features
  • stuff nose, nasal obstruction
  • ponding headache
  • increased BP, bradycardia, arrhythmia
  • flushing of body above the level of cord injury with sweating
  • blurring of vision
  • cerebral hemorrhage or seizure d/t increased BP
  • MI
  • potentially fatal but reverse quickly if stimuli withdrawn
  • remove stimuli quickly
  • sublingual nifedipine to reduce BP
  • alpha or beta adrenergic blockers for a/c management
  • prevent further occurrence

  • frequent pressure relief in bed / chair
  • avoid sun burn / scald
  • comfortable clothing
  • good catheter management
  • good bowel care
  • endoscopic procedures done only in GA or SA
  • sympathectomy / sacral neurectomy / sacral rhizotomy / cordectomy / dorsal root ganglionectomy
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Orthopaedics made simple for DNB MS MRCS Support and Guidance for DNB Orthopaedics, MS Orthopaedics and Orthopaedic Surgeons. DNB Ortho MS Ortho MRCS Exam Guide Diplomate of National Board.Our site has been helping dnb ortho post graduates since a long time.It has been providing the dnb ortho theory question papers,dnb orthopedics solved question bank, davangere orthopaedic notes, sion orthopedic notes.We provide guidance to post graduates as to how to pass dnb and ms ortho exams, and aspiring orthopaedic surgeons surgical technique teaching videos and orthopaedic books and pdf.
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