1110 - Highlighting the role of a PM&R consult service for SCI patients in the acute hospital; a case report of autonomic dysreflexia in the setting of necrotizing fasciitis

30 year old male with history of C4ASIA-A spinal cord injury presents to the hospital with for sepsis, found to have necrotizing fasciitis of ischial wounds. The patient underwent surgical debridement with diverting colostomy complicated by perforation and pancolitis. Rehabilitation service was consulted and on initial evaluation, the patient was flushed, sweating, with concomitant hypertension. He reports having multiple autonomic dysreflexia (AD) episodes a day consistently for years and has not seen a spinal cord doctor in 9 years. Rehab team recommended an AD regimen for primary team to manage episodes including frequent repositioning and baclofen as well an air fluidized mattress and seating restrictions to minimize pressure on his wounds. Education was provided to the patient and team about the need for adequate treatment of post-operative pain in patients with complete SCI. With these changes, patient reported fewer AD episodes overall and discharged to home with close follow up.


Discussions: Although the patient was experiencing AD due to the stimuli of his infected wounds and surgical complications, there were multiple modalities and ways the rehab consult team could assist this patient with symptom management. This included advocating for an air fluidized mattress, pain medications, antihypertensives, and symptomatic management of chills and diaphoresis.

Conclusions: An inpatient PM&R consult team proved to be a vital resource in helping this patient adjust and manage his autonomic dysreflexia, resulting in fewer episodes and promoting safer outcomes for spinal cord injury patients in the acute hospital setting.