Quick Chart
  • 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
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.
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)
Advanced Care (AP)
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • Repeated or sustained episodes of autonomic dysreflexia can result in:
    • Intracerebral haemorrhage (CVA)
    • Myocardial infarction
    • Seizures

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