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TRIUMPH: Managing Autonomic Dysfunction in TBI
Presenter: Lindsay Mohney, MS, DO
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Knowledge Gap: 
The purpose of this activity is to educate healthcare providers with the most up-to-date information on Managing Autonomic Dysreflexia in TBI.

Target Audience
The target audience includes all healthcare professionals such as physicians, nurses, pharmacists and allied health professionals who would like to learn about Managing Autonomic Dysreflexia in TBI and how it pertains to their respective profession.

 
Release and Expiration Dates
4/17/2017 - 4/17/2020

Objectives

  1. Define paroxysmal autonomic instability with dystonia.
  2. Discuss assessment and diagnosis of autonomic dysfunction after TBI.
  3. Discuss management and treatment recommendations for paroxysmal autonomic instability with dystonia.

Biographical Info

Lindsay Mohney is a UAMS Physical Medicine & Rehabilitation 3rd  Year Resident. Chief Resident for 2017-2018 academic year. Interested in pursuing TBI fellowship. 




 


 

References

1. Blackman JA, Patrick P, Buck M, Rust R. Paroxysmal Autonomic Instability with Dytonia After Brain Injury. 2004, pp. 321-8.

2. Baguley IJ, Perkes IE, Fernandez-Ortega JF, Rabinstein AA, Dolce G, Hendricks HT. Paroxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria. Journal of neurotrauma. 2014, Vol. 31, 17.

3. Kim, Chong Tae. Cerebrally Mediated Autonomic Dysfunction. PM&R Knowedge Now. [Online] September 17, 2015. http://me.aapmr.org/kn/article.html?id=5.

4. W Jerry Mystw, Lisa P Fugare, Dantel M Clinchot. Assessment, Early Rehabilitation Intervention, and Prevention. [book auth.] Douglas I Katz, Ross D Zafonte Nathan D Zazler. Brain Injury Medicine - Principles and Practice. s.l. : Demos Medical, 2012.

5. Meyer, KS. Understanding paroxysmal sympathetic hyperactivity after traumatic brain injury. Surgical neurology international. 2014, Vol. 5, 13.

6. Baguley IJ, Slewa-Younana S, Heriseanu RE, Nott MT, Mudaliar Y, Nayyar V. The incidence of dysautonomia and its relationship with autonomic arousal following trauamtic brain injury. 2007, Vol. 21, 11, pp. 1175-1181.

7. Hilz MJ, Liu M, Koehn J, Wang R, Ammon F, Flanagan SR, Hösl KM. Valsalva maneuver unveils central baroreflex dysfunction with altered blood pressure control in persons with a history of mild traumatic brain injury. BMC Neurology. 2016, Vol. 16, 61.

8. Hilz MJ, DeFina PA, Anders S, Koehn J, Lang CJ, Pauli E, Flanagan SR, Schwab S, Marthol H. Frequency analysis unveils cardiac autonomic dysfunction after mild traumatic brain injury. Journal of Neurotrauma. 2011, Vol. 28, 9.

9. Hinson HE, Schreiber MA, Laurie AL, Baguley IJ, Bourdette D, Ling GS. Early Fever As a Predictor of Paroxysmal Sympathetic Hyperactivity in Traumatic Brain Injury. The Journal of Head Trauma Rehabilitation. 2017.

10. Lv LQ, Hou LJ, Yu MK, Qi XQ, Chen HR, Chen JX, Hu GH, Luo C, Lu YC. Prognostic influence and magnetic resonance imaging findings in paroxysmal sympathetic hyperactivity after severe traumatic brain injury. Journal of Neurotrauma. 2010, Vol. 27, 11.

11. Mehta NM, Bechard LJ, Leavitt K, Duggan C. Severe weight loss and hypermetabolic paroxysmal dysautonomia following hypoxic ischemic brain injury: the role of indirect calorimetry in the intensive care unit. Journal of parenteral and enteral nutrition. 2008, Vol. 32, 3.

12. IJ, Baguley, et al. Pharmacological management of Dysautonomia following traumatic brain injury. 2004. 18(5):409-17.

13. Chioléro RL, Breitenstein E, Thorin D, Christin L, de Tribolet N, Freeman J, Jéquier E, Schutz Y. Effects of propranolol on resting metabolic rate after severe head injury. Critical care medicine. 1989, Vol. 17, 4.

14. Ko A, Harada MY, Barmparas G, Thomsen GM, Alban RF, Bloom MB, Chung R, Melo N, Margulies DR, Ley EJ. Early propranolol after traumatic brain injury is associated with lower mortality. The journal of trauma and acute care surgery. 2016, Vol. 80, 4.

15. Schroeppel TJ, Sharpe JP, Magnotti LJ, Weinberg JA, Clement LP, Croce MA, Fabian TC. Traumatic brain injury and β-blockers: not all drugs are created equal. Journal of trauma and acute care surgery. 2014, Vol. 76, 2.

16. A Critical Review of the Pathophysiology of Dysautonomia Following Traumatic Brain Injury. Baguley, Jeriseanu, Cmeron, Nott, Slewa-Younan. 8:293-300, s.l. : Neurocrit Care, 2008.

17. Becker R, Benes L, Sure U, Hellwig D, Bertalanffy H. Intrathecal baclofen alleviates autonomic dysfunction in severe brain injury. Journal of Clinical Neuroscience. 2000, Vol. 7, 4.

18. Cuny E, Richer E, Castel JP. Dysautonomia syndrome in the acute recovery phase after traumatic brain injury: relief with intrathecal Baclofen therapy. Brain Injury . 2001, Vol. 15, 10.

19. Fernandez-Ortega JF, Prieto-Palomino MA, Garcia-Caballero M, Galeas-Lopez JL, Quesada-Garcia G, Baguley IJ. Paroxysmal sympathetic hyperactivity after traumatic brain injury: clinical and prognostic implications. Jounal of Neurotrauma. 2012, Vol. 29, 7.

20. Prognostic influence and computed tomography findings in dysautonomic crises after traumatic brain injury. Fernández-Ortega JF1, Prieto-Palomino MA, Muñoz-López A, Lebron-Gallardo M, Cabrera-Ortiz H, Quesada-García G. 61(5):1129-33, s.l. : J Trauma, 2006 Nov.

21. Laxe S, Terré R, León D, Bernabeu M. How does dysautonomia influence the outcome of traumatic brain injured patients admitted in a neurorehabilitation unit? Brain Injury. 2013, Vol. 27, 12.

 

Speaker Disclosures:
The planners, speakers, moderators, peer reviewers and /or panelists of this CE activity have no relevant financial relationships with commercial interests to disclose.

Planners: 
Kim Miller
Sarah Rhoads 
Susan Smith Dodson
Mark Jansen

Speaker:
Lindsay Mohney, MS, DO

Peer Reviewers: 
Kim Miller, MCHES


Instructions to obtain credit:

1.       Launch the activity 
2.       Complete the pre-test 
3.       View the entire activity online 
4.       Complete the post-test 
           (must pass the post-test with a score of 80% to receive credit)
           You may retake the post-test if you do not receive a passing score.
5.       Complete Evaluation 
Print certificate or transcript (Available in the “My Profile” tab).

 

ANCC Accreditation Statement:
The Office of Continuing Education, University of Arkansas for Medical Sciences is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation

Learn OnDemand Contact Us:
For information regarding this educational activity or website, please contact

UAMS Office of Continuing Education
4301 W. Markham #525
Little Rock, AR 72205
Phone: 501-661-7962 Fax: 501-661-7968

 

ACCME Accreditation Statement: 
The University of Arkansas for Medical Sciences (UAMS) Office of Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

 

UAMS Office of Continuing Education 
4301 West Markham Street #525 
Little Rock, AR 72205 
Phone: 501-661-7962 Fax: 501-661-7968

Direct Provider Statement 
The University of Arkansas for Medical Sciences (UAMS) Office of Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

 

Designation Statement 
The University of Arkansas for Medical Science Office of Continuing Education designates this live activity for a maximum of 1.00 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

Disclosure Policy statement
It is the policy of the University of Arkansas for Medical Sciences (UAMS) College of Medicine to ensure balance, independence, objectivity, and scientific rigor in all directly or jointly provided educational activities. All individuals who are in a position to control the content of the educational activity (course/activity directors, planning committee members, staff, teachers, or authors of CE) must disclose all relevant financial relationships they have with any commercial interest(s) as well as the nature of the relationship. Financial relationships of the individual’s spouse or partner must also be disclosed, if the nature of the relationship could influence the objectivity of the individual in a position to control the content of the CE. The ACCME describes relevant financial relationships as those in any amount occurring within the past 12 months that create a conflict of interest. Individuals who refuse to disclose will be disqualified from participation in the development, management, presentation, or evaluation of the CE activity.

 

 



Type:  Internet Activity (Enduring Material)
22 Registered Users
Credits
1 Hours> Non-Accredited

1 Credits> Accreditation Council for Continuing Medical Education> AMA PRA Category 1 Credit

1 Contact Hours> American Nurses Credentialing Center> ANCC

1 CECH, 1 CECH> National Commission for Health Education Credentialing, Inc. > CHES