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

• 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)

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• Empty leg bag and note volume
• Check tubing not blocked/kinked
• If catheter blocked remove and re-catheterise using lubricant containing lidocaine

• 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

• 10 mg Nifedipine sublingual or chewed or GTN spray 1-2 sprays, repeat every 20-30 min if needed

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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