Heart Brain Disconnect26 Apr

HEART-BRAIN DISCONNECT: ASYSTOLE COMPLICATING CERVICAL SPINE INJURY CPT Erik Manninen, MC (Associate), MAJ Alex Truesdell, MC (Associate) Walter Reed Army Medical Center, Washington, D.C. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Treatment Currently, no treatments are successful at reconnecting the disrupted autonomic pathways. The resultant bradycardia and asystole are commonly treated with episodic atropine—or an alternative vagolytic. The preferred treatment is primary prevention of the inciting stimuli. As examples, bladder distention may be avoided via frequent intermittent catheterizations, foley obstruction can be prevented through regular catheter maintenance, and administration of high flow oxygen prior to suctioning may limit inciting hypoxic episodes. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],AUTONOMIC NERVOUS SYSTEM AND CERVICAL CORD INJURY Pathogenesis Normally, sympathetic outflow to the heart occurs via preganglionic fibers exiting the spinal cord at thoracic levels T1 through T4 while parasympathetic innervation to the heart occurs via the vagus nerve, which exits the CNS at the level of the medulla. With complete cervical cord transection, descending sympathetic fibers to the viscera are interrupted, whereas descending parasympathetic fibers remain intact. Clinical Manifestations In the absence of a compensatory sympathetic signal, catastrophic bradycardia or asystole may result from common, normally benign, parasympathetic stimuli—such as bowel movements, bladder fullness, postural changes, or tracheal suctioning. ,[object Object],[object Object],[object Object],[object Object],[object Object],Blackmer J. Rehabilitation medicine: 1. Autonomic dysreflexia. CMAJ. 2003; 169 (9):931-35.

Heart Brain Disconnect26 Apr

Recomendados

Recomendados

Más contenido relacionado

Destacado

Destacado (19)

Más de jcm MD

Más de jcm MD (10)

Heart Brain Disconnect26 Apr