Autonomic Dysreflexia (A.D.)
Autonomic Dysreflexia (A.D.) can happen to people with spinal cord injuries above the T6 level. It occurs most often in the first year after the injury, but can happen throughout the person’s lifetime. It occurs when something causes irritation below the spinal cord level of injury. A warning signal travels up the spinal cord, but it is blocked at the level of injury. This starts a reflex action in the “fight or flight” center of the nervous system causing the blood pressure to increase until the irritant is removed. A.D. can be life-threatening.
Causes and Symptoms
Bladder: full bladder (most common cause), bladder infections and kidney stones
Bowel: stool in the rectum (second most common cause)
Skin: pressure sores, burns, tight-fitting clothing, ingrown toenails, pinched skin
Other: sitting on a foreign object, pregnancy, sexual intercourse, incorrect positioning, fractures, stomach ulcers, or childbirth
Blood Pressure Changes
Even a small increase in the blood pressure of 20 mmHg or more can signal A.D. Most people have a lower blood pressure than they used to. A small increase might be normal for other people, but could be dangerous for someone with A. D. We suggest that you have your blood pressure taken every year so that you will know what your normal or baseline blood pressure is.
Normal blood pressure: 100/64
Blood pressure during A. D.: 124/80
Ask your team of doctors and nurses if you should have a blood pressure cuff at home. They can teach you how to use one so you can check your blood pressure at home.
Do not ignore the symptoms of A. D.! Think about all causes and follow the steps below.
Step 1. Sit upright at a 90-degree angle and lower the legs if elevated. Blood pressure will drop due to the effects of gravity.
Step 2. Loosen all tight clothing, like elastic stockings and abdominal binders.
Step 3. Empty your bladder. Use lidocaine jelly to help numb the body’s reaction to the catheter.
- If on an intermittent cath program, catheterize now. If the volume is more than 500ml, clamp off tube and wait 10 minutes. Then continue
- If using a Foley cath, check for kinks in the tubing. If no kinks are found, change the Foley since there might be a blockage.
- Check for a full urine drainage bag and empty if needed.
Step 4. Check your bowel for stool. Insert lidocaine jelly into the rectum before checking the rectum for stool. Remove stool, if present. Do not use digital stimulation.
Step 5. Check your skin and your positioning. Look for skin being pinched, clothing too tight and pressure areas or broken bones.
Step 6. If you are prone to A.D., your doctor may give you a medicine to control the symptoms until the source of A.D. is known. Make sure you know how and when to take this medicine.
If the symptoms are not resolved by using the methods described, call your doctor right away or go to the nearest emergency room. A.D. can be life-threatening and needs to be taken care of quickly.
If you have any questions or concerns about this information, please call the rehab clinic nurses at (608) 263-6540.
We suggest that you carry a card listing the signs, symptoms, and treatment for A. D. with you at all times since you may not be able to direct your care during the crisis. Please cut out the card below. It can be folded to fit in your wallet.
Autonomic Dysreflexia (Autonomic dysreflexia) is a medical emergency. It occurs with a SCI of T6 or above, causing high blood pressure that may be life threatening.
Causes: full bladder (90% of cases), full bowel, pressure ulcer, bone fractures, infections, intercourse, tight clothing or shoes, blood clots, pregnancy or labor, bladder/kidney stones, internal injuries (ulcers, appendicitis).
Symptoms: severe headaches, high blood pressure, slowed heart rate, flushed face, goose bumps, sweating above level of injury, stuffy nose.
Treatment: Sit up at 90º, check blood pressure, empty bladder using anesthetic lubricant on the catheter, or check Foley/condom catheter for kinks or plugging.
If blood pressure remains up
If the source can't be found and blood pressure remains high, call your doctor or go to the nearest emergency room.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 01/11/2013
Copyright © 01/11/2013 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4590
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