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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: Severe Autonomic Dysfunction 1. I suffer severe autonomic dysfunction due to a severe head and neck injury from a skiing accident in 1990. I function pretty good except if I do any exceretion or am stressed. I have hypotension - my normal BP is 90/60 and a pulse rate between 30-50. I suffer pre-syncope & synocope whenever my parasympathic nervous system kicks in to counter a sympathic stimulus. 2. This condition has been confirmed by tilt-table, EMG's, EKG's, PET scans, MRI's. I've been a test subject for some research projects at the IU Hospital. 3. I know I'm very fortunate to be a spinal cord injury survior. I recently had a bout with a stomach flu - vomiting and diareah triggered an autonomic attack. I called 911 after I came to, the paramedic's transported me to the hospital. The paramedic's couldn't start an IV because my vascular system is affected. I couldn't get anyone to understand what was happenning to me. At the ER, some blood work was ordered - but I was just left hooked up to monitors. Finally, a couple of hours later after the blood work came back, I was given an IV, antibodics, anti-nausau and pain medication. I couldn't expalin that my vital signs were off the chart for me. The BP 150/90 and a pulse of 85-95 might be in a normal range for someone else but not me - my body felt like it was being ravaged by a storm with my head being blasted by the surf and the waves. 4. My main question is how can I explain to Emergency Personnel what an autonomic attack is? I don't want to fight this battle again in the future. I'm followed every 3-6 months by an electro-cardiogolist and a general practioneer, so this would only come up in an emergency situation. 5. I'm interested in any research being conducted in the area of autonomc dysfunction. Thanks The situation you describe is very famiiliar to people who work in the area of spinal injury and rehabilitation but is obviusly full of risks in a situation where you are dealing with people who do not know your history. A number of options suggest themselves, in an ER situation everyone is very grateful to have access to any possibe information on a patients past medical history since so many people are wheeled in off the street without recodrs and unable togive a history themselves. You could ask the cardilogist to give you a letter which explains your condition and the normal range of vital signs in yoru condition, copy the letter, laminate it if nrecessary, have copies at home in your wallet in your car etc. I would also suggest that you write the director of the ER closest to home explaining what happened and asking him to keep the letter in his file. Ultimatly the best option in this case is an official, letter spelling out you special needs. You should also wear a medic-alert bracelet orther device which explains the situation, there are searched for avidly by ER personnel and in a situation where information is scanty are usually given maximum attention. |
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