Rebecca Evans CBE

Written by on 13th October 2020. Posted in News

We at TREAT are delighted with the news that our wonderful Patron, Rebecca Evans has been appointed CBE in the Queen’s Birthday Honours list.

It gives us great pleasure to offer Rebecca our heartiest congratulations.

Autonomic Dysreflexia Seminar 27th February

Written by on 16th February 2020. Posted in News

Autonomic Dysreflexia Seminar - Thursday 27th February 2020

ttw-wg

TREAT, in collaboration with the Welsh Government, will be holding a seminar at the Vale Hotel, Hensol on the afternoon of Thursday 27th February 2020 to raise awareness of the condition of autonomic dysreflexia, a potentially life-threatening disturbance of the autonomic nervous system leading to dangerous elevation of blood pressure and the risk of heart attack or stroke; it is encountered in those with spinal injury and some other central nervous system dysfunctions.
The condition is poorly recognised even in hospitals and the emergency treatment is similarly inadequately appreciated.
Invitations to attend have been accepted by a range of healthcare professionals from across Wales.
TREAT, in collaboration with the Welsh Government, will be holding a seminar at the Vale Hotel, Hensol on the afternoon of Thursday 27th February 2020 to raise awareness of the condition of autonomic dysreflexia, a potentially life-threatening disturbance of the autonomic nervous system leading to dangerous elevation of blood pressure and the risk of heart attack or stroke; it is encountered in those with spinal injury and some other central nervous system dysfunctions.
The condition is poorly recognised even in hospitals and the emergency treatment is similarly inadequately appreciated.
Invitations to attend (see below) have been accepted by a range of healthcare professionals from across Wales.

20 December 2019

Autonomic dysreflexia event Thursday 27th February 2020

A seminar will be held on the management of autonomic dysreflexia (AD) at the Tredodridge room, Vale Resort Hotel from 1pm to 4pm on Thursday the 27th February 2020.

This event is a collaborative partnership between the charity TREAT and the Welsh Government.

In October 2018 Welsh Government published a Patient Safety Notice (PSN046) titled ‘Resources to support safer bowel care for patients at risk of autonomic dysreflexia’.

Since the publication of this safety notice it has become evident that progress has been made on bowel care related to preventing AD. However, there is a lack of knowledge and understanding about the emergency aspects of AD and the potential for it to be a life-threatening condition for spinal cord injured individuals.

This seminar will raise awareness about the prevention, management and specifically about the emergency care of individuals during an episode of autonomic dysreflexia.

Professor Jean White CBE

Chief Nursing Officer
Nurse Director NHS Wales
Department for Health and Social Services

Attached also is a document from the Royal National Orthopaedic Hospital regarding advice about AD.

Autonomic Dysreflexia
Autonomic Dysreflexia is a life-threatening condition that can cause death.
The most common causes of Autonomic Dysreflexia are bladder and bowel distension.
Signs and Symptoms: Raised BP, bradycardia, pounding headache, flushing, sweating or blotching above level of injury; pale, cold, goose bumps below level of injury.
If a patient has an episode of Autonomic Dysreflexia:
1. Sit patient up (keep patient sitting or upright until BP returns to normal)
2. Loosen or remove any tight clothing
3. Monitor BP every 2-5 minutes
4. Check bowel (constipation, haemorrhoids) and bladder (catheter kinks/obstructions etc., bladder distension)
5. Insert indwelling catheter if not already in place/ rectal examination
o If systolic BP > 150mmHg instigate immediate pharmacological management:
o 10 mg Nifedipine sublingual or chewed or GTN spray 1-2 sprays, repeat every 20-30 min if needed
o An individual with a spinal cord injury above T6 typically has a normal systolic Blood Pressure (BP) in the 90-110mmHg range. Therefore, a BP of 20-40mmHg above baseline may be a sign of Autonomic Dysreflexia (NB: Autonomic Dysreflexia has occurred in patients with lesions at T8 and above).
o Remind patients and their carers about prevention and management of Autonomic Dysreflexia and encourage patient to carry Nifedipine/GTN.
Definition
Autonomic Dysreflexia
A clinical emergency in individuals with spinal cord injury (scireproject.com). Autonomic Dysreflexia is an uninhibited sympathetic nervous system response to a variety of noxious stimuli occurring in people with spinal cord injury at the thoracic six (T6) level and above. (Consortium for Spinal Cord Medicine Clinical Practice Guidelines). (NB: Autonomic Dysreflexia has occurred in patients with lesions at T8 and above).
Pathophysiology

Reproduced from Ontario Neurotrauma Foundation. Autosomal Dysreflexia. Caring for Persons with Spinal Cord Injury – e-learning resource for family physicians.
A stimulus, such as a distended bowel or bladder that occurs below the level of spinal cord injury (1) sends an afferent signal to the spinal cord (2). The impulses from the noxious stimulus are unable to ascend past the spinal cord lesion and may activate a massive sympathetic reflex (3) causing widespread vasoconstriction of the blood vessels below the level of the injury (4) resulting in hypertension and other signs of sympathetic stimulation (5).
Two vasomotor brainstem reflexes (6) occur to lower BP:
• Increased parasympathetic stimulation to the heart resulting in bradycardia or “relative” slowing of heart rate (this alone cannot compensate for severe vasoconstriction) (7a)
• Increased sympathetic inhibitory outflow from vasomotor centres above the spinal cord injury, which results in profuse sweating and vasodilatation of the skin above level of injury as the impulses cannot pass below the injured level and cannot dilate the splanchnic bed to accommodate the extra circulating blood due to increased peripheral resistance (7b)
As the spinal cord injury separates the parasympathetic (craniosacral division of ANS) from the sympathetic branch (thoracolumbar chain) the negative feedback loop is affected. The body is unable to restore autonomic equilibrium when presented with noxious stimulus below the level of injury so BP will keep rising until the stimulus is removed.
Signs and symptoms – Clinical Features
• Hypertension: Greater than 20mmHg above baseline for both systolic and diastolic (Typical BP in tetraplegia patient is 90-110/60-70mmHg supine
• BP is commonly lower when patient is sitting due to orthostatic hypotension)
• Severe bilateral pounding headache
• Diaphoresis or flushing above the level of the spinal cord lesion (Diaphoresis can be profuse)
• Nasal congestion
• Visual changes or disturbances
• Bradycardia or tachycardia (Bradycardia at onset, tachycardia may follow)
• Pallor or gooseflesh below the level of the spinal cord lesion
• Respiratory distress or bronchospasms
• Anxiety (Apprehension over impending physical problem to fear of death is common)
• Metallic taste in mouth
• Significantly elevated BP with minimal or no symptoms (Silent Autonomic Dysreflexia)
Causes
Autonomic Dysreflexia has many potential causes. It is essential that the specific cause be identified and treated in order to resolve an episode of Autonomic Dysreflexia and to prevent recurrence. Any noxious stimuli below the level of injury may result in Autonomic Dysreflexia. Bladder and bowel problems are the most common causes of Autonomic Dysreflexia.
System Noxious Stimuli
Dermatologic Pressure sore
Ingrown toenail
Constrictive clothing
Burns, blisters, sunburn, frostbite
Musculoskeletal Fracture
Heterotopic ossification
Dislocation
Reproductive Female: menstruation, vaginitis, labour and delivery
Male: ejaculation, epididymitis, scrotal compression, testicular torsion
Haematological Deep vein thrombosis
Pulmonary embolus
Central Nervous System Syringomyelia
Medications Nasal decongestants
Misoprostol
Sympathomimetics
Stimulants
Management and recommendations
Sit patient up (keep patient sitting or upright until BP returns to normal)
Loosen or remove any tight clothing
Monitor BP every 2-5 minutes
For patients with catheter:
• empty leg bag and note volume
• check tubing not blocked/kinked
• if catheter blocked remove and re-catheterise using lubricant containing lidocaine
For patients without catheter:
• if bladder distended and patient unable to pass urine insert catheter using lubricant containing lidocaine
If bladder distension excluded – gently examine per rectum
For faecal mass in rectum:
• gently insert gloved finger covered in lidocaine jelly into rectum and remove faecal mass
If bladder and bowel excluded check the above (see table of causes)
If systolic BP > 150mmHg instigate immediate pharmacological management:
• 10 mg Nifedipine sublingual or chewed or GTN spray 1-2 sprays, repeat every 20-30 min if needed
If symptoms do not resolve quickly patient should be admitted to hospital for further assessment and management or contact a spinal cord injury centre for further advice.
Follow-up
• Blood pressure should be monitored by patient/carer for at least 2 hours after an episode to ensure no rebound hypotension and no Autonomic Dysreflexia recurrence
• Provide patient with information to prevent further episodes
• Encourage patient to maintain a record of their BP using a home BP cuff and know their baseline BP
• Provide patient with medication (e.g. Nifedipine 10mg sublingual or GTN spray) to treat episodes
• If patient has recurrent episodes of Autonomic Dysreflexia, monitor closely and consider referring to a specialist in spinal cord injury
References
Ontario Neurotrauma Foundation. Caring for Persons with Spinal Cord Injury – e-learning resource for family physicians. eprimarycare.onf.org/AutonomicDysreflexia.html
Royal College of Physicians (2008). Chronic Spinal Cord Injury. Management of Patients in Acute Hospital Settings. www.rcplondon.ac.uk.

TREAT AGM 2019

Written by on 11th May 2019. Posted in News

TREAT Trust will hold their AGM on Thursday 16th May 2019.

The meeting starts at 6PM at the Village Hotel, Langdon Rd, Swansea SA1 8QY

Open Letter outlining current position

Written by on 2nd July 2018. Posted in News

We at TREAT considered that, given the difficult political times on a number of fronts, our partners and supporters would welcome an update on our efforts at TREAT. This open letter is a summary of our present situation.

Treat Trust – Open Letter 2018 for sending

Annual General Meeting – 24th May 2018

Written by on 18th May 2018. Posted in News

Annual General Meeting for TREAT Trust Wales will be held on Thursday 24th May 2018 at 6.00 PM at 76 New Road, Gellinudd, Pontardawe SA8 3DY.  Member of the public are welcome.

 

TREAT Wales Roadshow 2016

Written by on 2nd March 2016. Posted in News

We would like to say a huge Thank You to everyone who attended the TREAT Wales Roadshow 2016 at The Village Hotel in Swansea. For those of you that didn't make it, we are delighted to be able to provide you with some exclusive video clips of the event via our You Tube Channel. To view use the links below or visit our channel.

> Question & Answer session

> Sandra Williams from Headley Court

> Brian Carling from Aspire Centre

> Rosalind Martin

Michael Sheen’s Message for TREAT

Written by on 24th November 2015. Posted in News

TREAT Patron, Michael Sheen, has sent us this lovely message ready for our 'Have Your Say' Roadshow this Friday, 27th November.

 

Why Support TREAT?

Written by on 24th November 2015. Posted in News

One of our patrons, comedian Bennett Arron, has sent us this little video about why he supports TREAT Trust Wales.

Message from Paul Potts, TREAT President

Written by on 24th November 2015. Posted in News

Ahead of our 'Have Your Say' Roadshow this Friday, 27th November. Our President and supporter, Paul Potts, has sent us this message.

Jonathan Davies Sends Message of Support for TREAT Roadshow

Written by on 17th November 2015. Posted in News

Jonathan Davies, our newest patron, has sent us this message of support for our 'Have Your Say' roadshow on 27th November 2015.

For more information on our TREAT Roadshow 2015 click here. Don't forget to RSVP to treatroadshow@gmail.com.

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