Autonomic Dysreflexia (Severe high blood pressure, Beware if have stomach,bowel or bladder conditions, pregnant, skin, foot conditions and/or upper back injury) - Medtick
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Autonomic Dysreflexia (Severe high blood pressure, Beware if have stomach,bowel or bladder conditions, pregnant, skin, foot conditions and/or upper back injury)

What is it?

This condition occurs if one has injured their spinal cord in the upper back region (spinal cord region -T6 and above).

  • The spinal cord below this region controls our ‘flight and fright’ response  (i.e. bladder, bowels , emotional reactions) works as normal however because the upper part of the spine is damaged this response becomes out of control (because the nerve signals from ones organs are blocked or partially blocked to the brain) and this  can cause a severe increase in blood pressure (blood vessels become narrower),  putting pressure on the heart to work harder as wells as slowing the heart beat down.
  • This may lead to an heart attack and/or stroke and/or seizures.
Please do not wait, call for an ambulance if one has hypertensive crisis blood pressure (see image for blood pressure figures)

Cause

Medication

  • Nasal decongestants
  • Misoprostol
  • Sympathomimetics
  • Stimulants

Female only

Male only

Symptoms

  • Headache which is on and off or a constant headache longer than 24 hours?
  • Heavy sweating?
  • Anxiety?
  • Abdominal pain and/or are constant violently vomiting or vomiting longer than two days (one day if a child)?
  • Balance and dizziness?
  • General discomfort (muscle weakness), uneasiness or ill feeling (malaise) and/or fatigue (tiredness) (Parent/Adult: Please check baby/young child is not moving as they normally do or sleeping a lot more than normal)?
  • Hot flushes/Flushed face?
  • Blurred/double vision?
  • Runny nose, congestion, cold not cleared by over the counter medication or greater than three weeks?
  • Regular nose bleeds?
  • Short of breath/breathing difficulties?
  • Heart palpitations, irregular heartbeats?
  • Altered heart rhythm (slow beating of heart)?
  • Goosebumps/feeling cold on the lower body?
  • Blotches of skin rash above the level of spinal cord injury?
  • Swollen ankles?
  • Constantly/ hard to control (even after taking medication)/fluctuations in  high blood pressure?

Male only:

Complications /Information to beware of/General tips:

Medical Emergency Condition

And/or do not wait, phone for an ambulance if have or develop:

Please do not wait, call for an ambulance if one has hypertensive crisis blood pressure (see image for blood pressure figures)
If have an episode:
  • Sit patient up (keep patient sitting or upright until BP returns to normal)
  • Loosen or remove any tight clothing
  • Monitor BP every 2-5 minutes
  • Give 10 mg Nifedipine sublingual or chewed or GTN spray 1-2 sprays, repeat every 20-30 min if needed (if one is comfortable in doing so)
Information for carers with experience otherwise, call  do not wait call for an ambulance
For patients with catheter:
  • Empty leg bag and note volume
  • Check tubing not blocked/kinked
  • If catheter blocked remove and re-catheterise using lubricant containing lidocaine
For patients without catheter:
  • if bladder distended and patient unable to pass urine insert catheter using lubricant containing lidocaine
If bladder distension excluded – gently examine per rectumFor faecal mass in rectum:
  • Gently insert gloved finger covered in lidocaine jelly into rectum and remove faecal mass
If bladder and bowel excluded:If systolic BP > 150 mmHg and have been advised by your prescriber otherwise do not wait , call for an ambulance:
  • 10 mg Nifedipine sublingual or chewed or GTN spray 1-2 sprays, repeat every 20-30 min if needed
If symptoms do not resolve quickly patient should be admitted to hospital for further assessment and management or contact a spinal cord injury centre for further advice.
Follow-up
  • Blood pressure should be monitored by patient/carer for at least 2 hours after an episode to ensure no rebound hypotension and no Autonomic Dysreflexia recurrence
  • Provide patient with information to prevent further episodes
  • Encourage patient to maintain a record of their BP using a home BP cuff and know their baseline BP
  • Provide patient with medication (e.g. Nifedipine 10mg sublingual or GTN spray) to treat episodes
  • If patient has recurrent episodes of Autonomic Dysreflexia, monitor closely and consider referring to a specialist in spinal cord injury
References Ontario Neurotrauma Foundation. Caring for Persons with Spinal Cord Injury – e-learning resource for family physicians. 
eprimarycare.onf.org/
AutonomicDysreflexia.htmlRoyal College of Physicians (2008). Chronic Spinal Cord Injury. Management of Patients in Acute Hospital Settings. www.rcplondon.ac.uk.

Detailed Information

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