CAUSES
Autonomic dysreflexia is generally brought on by something that would have signaled pain or discomfort in you before your injury. Some possible causes are listed below, with the most common once first.
- A full or distended bladder (frequently caused by a plugged or twisted catheter)
- Stool impaction (severe constipation)
- Infections (of the bladder, etc.)
- Tests and procedures (cystoscopy, gynecological exam)
- Pressure sores (decubiti)
- Traumatic pain (severe cuts or broken bones)
- Hot and cold temperatures
- Sunburn
- Tight clothes
- Pressure on the testicles or penis
- Severe menstrual cramps, labor (uterine contractions)
- Stomach ulcers
- Some drugs (digoxin, etc.)
- Ejaculation
What To Do
- Sit up if you are lying down. This will decrease your blood pressure.
- Find and remove the cause. Autonomic dysreflexia usually will not go away until the cause of the problem has been corrected.
- Check for bladder problems first. If you do not have a catheter in place, catheterize yourself. Empty your bladder slowly by lifting the draining end of your catheter. If you empty your bladder too fast, you may cause it to go into spasm, which can cause your blood pressure to go up again.
- Check for bowel problems next. If your bladder is not the cause of the high blood pressure, check your bowel for stool. If there is stool in your rectum, you will need to remove it manually. Before removing the stool, you should apply numbing medicine, such as lidocaine, to the anus and then wait five minutes for the medicine to work. This will prevent further stimulation to the area, which can cause your blood pressure to go up even more.
- Check for skin problems. If neither your bowel nor your bladder seems to be the cause, strip yourself and look for cuts, bruises, or ulcers on your body.
- If the symptoms do not go away or your blood pressure continues to be high, greater than 160 systolic, despite the above measures: apply nitroglycerin ointment to your skin above the level of injury or take hydralazine or nifedipine if your physician has given you this medication. This will lower your blood pressure while you are trying to find out why this has happened. Only certain patients who get autonomic dysreflexia a lot will be given this medication.
- GET HELP if you can’t find the cause. Call or go to the nearest hospital. Autonomic dysreflexia is an unusual problem, and not all health providers will know how to treat it. Present your Medical Alert Card for Autonomic Dysreflexia. (See figure 11.2.)
A physician should be notified immediately, because this is a medical emergency.
PREVENTION
You can prevent these symptoms in many cases, but not always.
Since the most common causes of autonomic dysreflexia are a full or distended (bloated) bladder and impactions of the bowel, you can prevent this from happening by making sure that:
- Your bladder is emptied routinely,
- Your catheter is draining well, and
- You have routine bowel movements.
You may be one of those people who just have this problem more often than others. In this case, your medical provider may put you on medication to prevent it. If you have problems with autonomic dysreflexia, you should have a blood pressure cuff at home and learn how to use it.
REMEMBER: If you do develop autonomic dysreflexia, you will soon learn what causes it for you. You will then be able to treat it quickly and effectively.
CARRY A CARD!
Figure 11.2 is an example of a card you can cut out and carry in your wallet. Put your name on the card in the space after "The bearer of this card". Let people know you have this card and use it with medical staff to instruct in emergency care. It may save your life!
FIGURE 11.2. Wallet Size Card for Autonomic Dysreflexia
| Medical Alert Card for Autonomic Dysreflexia
The bearer of this card,
___________________________________,
is at risk for autonomic dysreflexia, a life-threatening complication of spinal cord injuries above the T7 level. It is caused by an exaggerated sympathetic nervous system response to a noxious stimulus below the level of injury. The usual etiologies of AD are inadequate emptying of the bladder, a full bowel, tight clothing, ingrown toenail, etc.
The symptoms can include elevated blood pressure, headache, nasal congestion, bradycardia, and flushing (above the level of injury). Please note the normal blood pressure for an SCI patient is 90/60. If the AD is unresolved, it may result in myocardial infarction, stroke, retinal hemorrhage, or death. It is essential that the source be identified and the elevated BP be resolved immediately. Please see reverse of this card for details of treatment.
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Autonomic Dysreflexia Treatment
- Raise the head of the bed up to 90 degrees or sit the person upright.
- Check for the source of the AD: full bladder or bowel, tight clothing, ingrown toenail, pressure ulcer, or any other noxious stimulus. Removing the cause will usually eliminate or decrease the symptoms.
- Monitor the blood pressure and pulse every 5 minutes.
- Drain or irrigate the bladder, using a topical anesthetic jelly for catheterization.
- Check the rectum for stool, after first applying an anesthetic ointment to the rectal wall. If stool is present, begin digital stimulation to promote reflex defecation.
- If SBP is above 160, apply one inch of nitro paste to hairless skin, and cover with clear occlusive wrap.
- If elevated SBP continues, apply one additional inch of nitro paste, to equal two inches.
- Wipe off nitro paste when SBP decreases to 130.
- If SBP remains elevated despite two inches of nitro paste, give 10 mg of hydralazine. If SBP remains elevated after 10 minutes, give an additional 10 mg of hydralazine.
- If SBP remains refractory to the above treatments, give 10 mg of bite-and-swallow nifedipine. If nifedipine is given, the patient is at risk for hypotension once the AD is controlled and must be monitored closely for several hours after administration of nifedipine.
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Download this AD Medical Alert Card in Microsoft Word format.
RESOURCES
Publications
Autonomic Dysreflexia: What You Should Know
Purchase
PVA Distribution Center
PO Box 753
Waldorf, MD 20604-0753
(888) 860-7244
Download: www.pva.org
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Autonomic Dysreflexia