Autonomic Dysreflexia

UNCONTROLLED WHEN PRINTED

Quick Chart

Introduction

Autonomic dysreflexia is a medical emergency, characterised by the onset of acute hypertension in patients with spinal cord injuries above the level of T6. Bradycardia, vasodilation and sweating above the neurological level of injury are associated with compensatory parasympathetic activation.
A noxious stimulus below the level of injury leads to severe sympathetic activation and intense vasoconstriction below the level of the lesion. Examples of noxious stimuli include blocked urinary catheter, urinary tract infection or physical irritation or injury.

Clinical Presentation

Sudden hypertension
Pounding headache, worsening as BP rises
Bradycardia
Sweating and flushing above level of injury and skin pallor below level of injury
Shortness of breath

Exclusion Criteria

Risk Assessment

Autonomic dysreflexia should be considered when managing a patient with SCI with suspected cause when systolic blood pressure ≥20mmHg above resting level (if known) OR systolic blood pressure ≥160mmHg.
Transport the patient even if the symptoms are relieved as the cause of autonomic dysreflexia requires proper identification and management to prevent subsequent insult or injury.

Management

Primary Care

Primary Survey
Reassurance (continuous)
Limit patients exertion as much as is practically possible
Vital Sign Survey (monitor regularly including pre-and-post intervention pain scores)
Consider Oxygen if indicated
Position – sit the patient upright to induce an orthostatic reduction in blood pressure.
Loosen tight clothing

Intermediate Care (EMT / Level 2)