Autonomic Dysreflexia - A possible life threatening situation

This article is from the Pushin' On Newsletter, Vol 15[1], Winter, 1997. Published by: The Medical RRTC in Secondary Complications in SCI, 619 19th St S, Birmingham, AL 35249-7330.

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Autonomic Dysreflexia, sometimes called hyperreflexia or AD, can occur in persons with a spinal cord injury at or above the T6 level . AD happens when there is an irritation, pain, or stimulus to the nervous system below the level of injury. The irritated area sends a signal to the brain but it is not able to reach the brain. A reflex action takes place, tightening blood vessels, causing the blood pressure to rise. If the high blood pressure is not controlled it may cause a stroke, seizure, or death.

Signs or Symptoms of AD are:

• high blood pressure
• seeing spots or blurred visions
• pounding headache
• nasal stuffiness
• flushed face
• red blotching on chest
• sweating above level of injury
• goose bumps
• cool, clammy skin
• nausea
• feeling anxious

If you experience any of these symptoms:

1. Sit up or raise the head of the bed IMMEDIATELY.
2. Look for the cause and remove the irritation. It may be something as simple as tight clothing or an impacted bowel.

• Check Bladder to see if it is full, stretched, or there is any infection.
  • Is the catheter plugged or kinked? Remove kinks, irrigate if not draining.
  • Is the bladder full? Catheterize. Empty the bladder slowly. Emptying too quickly may cause spasms, causing one's blood pressure to rise again. Drain no more than 500 cc at one time.
  • Is the leg bag full? Empty bag.
  • Is an infection present? Treat as prescribed by physician.
• Check Bowel to see if there is sign of constipation or impaction? This can stretch the bowel.
  • Is there stool in the rectum? Apply numbing medication (xylocaine jelly) and wait 5 minutes. Remove stool gently.
  • Keep stool as soft as possible.
• Check Skin for pressure sores, painful stimulus (cuts, burns, bruises, sunburn, or pressure on the body) or ingrown toenails.
  • Loosen tight clothing.
  • Remove any sharp objects in pockets or on seat cushion.
  • Reduce irritation from cuts, bites, or burns with cold cloth or medication.
  • Trim ingrown toenails. Anesthetize area first and treat for infection if present.
• Check for Irritation related to gender and/or sexual activity.
  • Pressure on the testicles or penis during sexual activity and ejaculation (for males) or orgasm (for females) can cause an AD episode. Men and women empty their bowel and bladder before sexual activity. Talk to doctor about using medication such as xylocaine jelly or nitropaste patches. If AD symptoms occur, stop, sit up and rest.
  • Contractions of uterus before and during menstruation or during labor and delivery may also cause AD.
  • Other sources of irritation are medical tests and procedures, such as cystoscopy or gynecological exams, stomach ulcers, or some drugs.

You can help prevent AD by:

• Keeping your catheter equipment clean and draining freely;
• Emptying your bladder routinely;
• Following a regular bowel program;
• Checking skin daily;
• Wearing loose fitting clothing; and
• Checking for painful stimuli and removing.
• Remember - Carry a Card! Give this to staff in an Emergency Room or your doctor's office if you have an AD attack.

Medical Alert cards are available from
Paralyzed Veterans of America (PVA), 1-800-424-8200 or a card is in the patient education book, Yes, You Can !, also available from PVA.

The following information can be printed, cut out, and carried in your billfold.

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Medical Alert Card - AutonomicDysreflexia
Autonomic Dysreflexia occurs in spinal cord injuries (SCI) at or above T6. Can be life threatening due to an increase in blood pressure.
Symptoms: pounding headache, flushed skin & sweating above level of injury, blurring vision, nasal stuffiness, goose bumps, nausea, and BP.
Causes: Full bladder or bowel, infection, constipation,skin ulcers, traumatic pain (broken bones or cuts) below level of injury, tight clothing, tests & procedures (cysto, GYN), ingrown toe nails, or any painful stimulus below level of injury.
Treatment:

1. Sit patient up. Counteract rise in BP with orthostatic hypotension.
2. Eliminate the cause! Look for noxious stimuli below level of injury. Ex: catheterize, check for impaction, change position to relieve pressure.
3. Treat elevated systolic blood pressure (>150)
   
4. Medications: Apply Nitroglycerine Paste. 1-2 inches to skin q 2 hrs. May wipe off if BP stable. Reapply if needed.
   or Administer Nifedipine 10 mg capsule (immediate release form). May repeat in 20-30 min if necessary. Avoid sublingual which can cause abrupt hypotension.
   IV Antihypertensives are secondary agents to be utilized in a monitored setting.
5. Treat symptomatic hypotension by laying down the individual and elevating the legs.
6. Anesthetize noxious stimuli prior to removal to prevent exacerbation of AD.
7. Monitor symptoms and BP for at least 2 hrs after the resolution of an AD episode.
8. Admit the patient if response to treatment is poor or cause has not been identified. A D can lead to seizures, stroke or death.
   
   UAB Medical RRTC in Secondary Complications in SCI

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   c 1997, updated 2001. Board of Trustees of the University of Alabama
   For permission to reprint for further distribution contact the SPINALCORD Information Manager.
   This publication is supported in part by a grant (#H133B80012) from the National Institute on Disability and Rehabilitation Research, Dept of Education, Washington, D.C. 20202. Opinions expressed in this document are not necessarily those of the granting agency.