Advice Needed: Helping Nurses Recognize a Dangerous but Obscure Condition

I wasn't there to witness the interaction objectively, so I can't comment on the actions of the medical team. However, by your account it definitely appeared you were in distresss, and hopefully next time (if), you'll be treated immediately. Even someone without a history of AD is in danger of stroking with a BP that high. Were you bradycardic?

i would think a nurse who works neuro, would be alerted to this risk.

working with sci pts, most, if not all nurses would know what to expect...

even a wrinkled sheet could precipate this crisis...as can constipation.

re the er nurse, i don't understand why you wouldn't have been immediately eval'd.

even if the triage nurse didn't know about ad, a bp of 200+/100+ is enough to warrant immediate assessment.

leslie

Get a Medic Alert bracelet or pendant; and carry a note from your physician, which you have had copied and shrunken in size and laminated. You can do the same for some text which explains the basics in a nutshell.

Do you see a neurologist that works at the hospital? Maybe you could see if he could give an inservice and ask to tell your story there.

I did an inservice on autonomic dysreflexia in pregnancy when I worked L&D. Hope I did my small part to spread the word about this condition. The nurses I worked with had never heard of it but now they have :)

I actually just wrote an article about that for Complex Child Magazine! :-) I was inspired after caring for a patient who had a history of that. Very scary stuff! This patient was in the med-surg unit and although I'm sure they could figure out the patient was in danger, they might not have known to check for whatever was triggering the event in order to stop it.

Even someone without a history of AD is in danger of stroking with a BP that high. Were you bradycardic?

While my resting heart rate during triage was 25+ beats per minute slower than my very high baseline, I was still WNL and not obviously bradycardic.

@NeoPediRN and Leslie -- That the nurses at my small local hospital didn't recognize the AD is one thing. But hearing from you both that anyone with a BP that high, regardless of a history of AD, should have been assessed immediately tells me there are bigger problems at hand.

Get a Medic Alert bracelet or pendant; and carry a note from your physician, which you have had copied and shrunken in size and laminated. You can do the same for some text which explains the basics in a nutshell.

I already carry a wallet card about AD, which I presented to both the nurse who checked me in and took vitals, and the triage nurse.

The Medic Alert bracelet is a great idea.

I don't know any physician or nurse who doensn't know what autonomic dysreflexia is. How strange.

I am far from the front-lines, being a student- but you are taking an excellent step right here by being vocal. It seems the overall tendency is to punt to the specialist or someone else though, doesn't it?

Education is key!

Thank you for sharing.

I know of this because of the old Discovery Health channel!

It happened to me during a recent trip to the ED for a gallbladder infection, the pain from which triggered AD. When I arrived at the hospital, my BP had spiked to 215/119. I was sweaty and had a severe headache, blurry vision, and anxiety, all of which are symptoms of AD. Yet despite alerting both the nurse who took my vitals and the triage nurse that I was having autonomic dysreflexia and showing them the wallet card I carry about AD, neither recognized my condition as potentially life-threatening -- I was actually taken back for treatment after a pre-teen boy with an ankle injury who was in no apparent distress. Luckily, I made it through this bout of AD without incident (except for the pounding headache).

I can explain why this might have happened to you in my ED.

We use the ESI triage system. Your presentation would have garnered you an acuity level of 2.

The ankle injury would have been an acuity level 4.

In my ED, we run a separate "Fast Track" area, staffed by an MD, RN, and a Tech. All of the level 4s and 5s go there. Everyone else (acuity level 3 and above) goes into the main part of the ED.

Because the Fast Track area is run separately, patients can be moved from the lobby and back to a room quickly, because turnover is so fast that beds become available in short order. In the main ED, workups take longer because they involve more resources, plus there are ambulances coming in that need beds, and so beds don't become available as quickly. It is not unusual for every single bed in the ED to be filled, leaving no place to put new patients coming in. Because of this, it is not at all unusual for 4s and 5s to be roomed before the 3s and above.

Since everybody waits in the same lobby, it's not unusual for people to notice that someone who hasn't been there as long or isn't as sick is being taken back sooner.

It is quite possible that the triage nurse did in fact recognize your condition and the severity of it, but simply had no bed to put you in.

One charge nurse I work with will fill every bed in an effort to empty out the lobby. This leaves us no place to put the really sick ones that need to be roomed immediately. The other charge nurse I work with always leaves one bed open, preferably a trauma bed. Had you come in when the former CN was on, you would have had to wait. Had you come in when the latter CN was on, you would have been roomed immediately.

Some doctors are really good about getting their workups done and their patients dispositioned efficiently, while others keep patients sitting for far too long. Sometimes, the charts are just not moving, and you've got nurses sitting around twiddling their thumbs waiting on the doctors.

Sometimes it's not about knowledge of the medical condition, but rather, other factors that have nothing to do with it.