The symptoms observed are described 'as frightening as a tornado to the untrained eye'. The signs of dysautonomia are high blood pressure (hypertension), rapid heart beat (arrhythmia), accelerated metabolism, abnormal high body temperature above (hyperthermia) above 105 degrees F), dilated pupils, cognitive impairment, changes in level of awareness/alertness, rapid breathing (tachypnea), poor eye tracking, abnormal profuse sweating and posturing (decerebrate or decorticate) and agitated or irritable behaviour. Not all those symptoms are necessarily present in people suffering from the syndrome.
Dysautonomia happens spontaneously and is unpredictable and uncontrolled. The brain becomes 'hyperactive' but the EEG and MRI/CT scans show no abnormality. It should not be mistaken for seizures. One should, however, be on the lookout for triggers. Those can include infection, nerve pain, psychological stress and undue environmental over-stimulation such as noise or medical/nursing procedures such as suctioning, turning or bathing. The treatment of dysautonoia is symptomatic, that is, by treating the presenting symptoms such as ventilatory management and medication (such as beta-blockers, morphine derivatives and bromocriptine), to reduce the neurological symptoms.
A quick response is necessary for controlling the storming episodes. Dysautonomia can become serious and even fatal, if not treated speedily, at worst leading to heart damage, cerebral haemorrhage, brain herniation and even malignant hypertension. Extreme hyperthermia and abnormally raised metabolic rate can also lead to further episodes of hypoxia, an increase in the risk of secondary brain injury and possible cell death, so treatment and monitoring of blood glucose, cooling down the body core temperature, increasing nutrition and hydration and management of contractures and spasms are also essential to avoid weight loss, skin breakdown and muscle wastage.
Needless to say, the impact of storming on the family is chaotic, stressful and distressing. Both family education and participation are important. Doctors and nursing staff should actively involve the family in all aspects of monitoring and managing dysautonomia by reviewing the causes, symptoms, duration, management and treatment of the storming episodes. Good treatment and management will reduce the need to admit the person to ICU care and the family have a big role to play in the symptom monitoring, identifying triggers or treating an episode. The family will gain the sense of security and control by helping in the care of their loved one. The family have a lot to offer by carrying out tasks such as putting a cool cloth on the forehead, turning the fan on or removing the covers, aiding in bathing, helping their loved one to relax, identifying triggers and monitoring their response to medication.
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