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NEUROTRAUMA REVIEW If malignant tachycardia and/or hyper- tension persist once you have tried to elimi- nate the source of the irritation, establish IV access and transport with the head of the cot raised to 30–35 degrees (to mini- mize intracranial pressure). Then call your medical control physician promptly and ask how they want you to proceed. Depending on circumstances, the doctor may have you continue relatively noninvasive care or move on to administration of an alpha 2 agonist, beta-blocking medication, calcium channel- blocking medication or vasodilator. 4 Regardless of the choice of treatment, the most important job for us as EMS providers is to recognize the situation, make the right diagnosis and fnd and remove the cause of the problem. Being good, diligent detectives and using the resources at hand can make the difference for our patients between rapid recovery at the scene and prolonged hospital stay, and can sometimes avoid the devastating outcomes of stroke or MI. And that's worth our while. REFERENCES 1. Tintinalli JE, et al. Adults With Physical Disabilities, Spinal Cord Injury. In: Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 6 th ed. New York: McGraw Hill, 2004. 2. James JJ, Svircev JN, Buhrer R, Heard L, Burns SP. The use of a protocol for the management of autonomic dysrefexia in an inpatient spinal cord injury unit. Arch Phys Med Rehab, 2006 Nov; 87(11): e45. 3. Breault G, Altaweel W, Corcos J. Management of autonomic dysrefexia. Current Bladder Dysfunction Reports, 2008 Mar; 3(1): 13–6. 4. Abrams GM, Wakasa M. Chronic complications of spinal cord injury. UpToDate.com, www.uptodate.com/contents/ chronic-complications-of-spinal-cord-injury. BIBLIOGRAPHY Santajuliana D, et al. Contribution of alpha- and beta- adrenoceptors and neuropeptide-Y to autonomic dysrefexia. Clin Auton Res, 1995 Apr; 5(2): 91–7. Krassioukov A, et al; Spinal Cord Injury Rehabilitation Evidence Research Team. A systematic review of the management of autonomic dysrefexia after spinal cord injury. Arch Phys Med Rehabil, 2009 Apr; 90(4): 682–95. Tiffany Bombard, NREMT-P, MD, has been an EMS provider, frefghter and paramedic for many years in Vermont, Utah, New York, New Hampshire and Maine. She is currently a resident emergency physi- cian at Albany Medical Center and a paramedic for the Albany County Sheriff's Offce in New York. E-mail bombieskifast@yahoo.com. 1. The sympathetic nervous system nerves exit the spinal cord just below vertebrae: • T1, T4, T10 and L1 • C1–C7 • T1–T12 • T1–L2 2. Patients with severe spinal injury above the ________ vertebra are at risk for autonomic dysrefexia. • C7 • T1 • T6 • L2 3. Autonomic dysrefexia is most commonly caused by stimuli from: • A fecal impaction or full rectum • A urinary tract infection or full bladder • Pregnancy • An ingrown toenail • All of the above 4. A hallmark sign of autonomic dysrefexia is: • Meiosis • Hypertension • Pruritic skin, especially after hot showers • Pallor to all levels of skin on the paramedic Review Questions Answers at EMSWorld.com/11307652 For More Information Circle 28 on Reader Service Card For More Information Circle 29 on Reader Service Card 888-458-6546 3121 Millers Lane Louisville, KY 40216 Tel: 502-775-8303 Fax: 502-772-0548 S A F E T Y A P P L I A N C E C O M P A N Y www.junkinsafety.com PROUDLY MANUFAC TURED IN THE USA 600 Series Easy-Fold Stretchers JSA-602 JSA-603 All Junkin Easy-Fold Stretchers come with 2" wide standard, automotive-style patient restraint straps and 18 oz. fungus and rot resistant vinyl covers for long-lasting durability and easy clean-up. Each fold to a compact size for easy storage. JSA-604-S Special thanks to Marc Minkler, NREMT-P; Matthew Morgan, DO; Michael W. Dailey, MD, and to the prehospital provid- ers of the Albany County Sheriff's Offce for help with these articles. EMSWORLD.com | APRIL 2014 55 EMS_52-55_NeuroP40414.indd 55 3/17/14 7:37 AM