Autonomic dysreflexia can be life-threatening. It requires quick and correct action. Unfortunately, many healthcare providers are not familiar with this condition. That is why is very important for you, and those close to, to learn about it. You may have to guide your own treatment by ensuring that healthcare professionals, whether in an ambulance or a hospital, are thinking about autonomic dysreflexia when they are treating you.

Signs & Symptoms

• Pounding headache (caused by the elevation in blood pressure)

• Goose bumps

• Heavy sweating, especially in your face, neck & shoulders - this is usually, but not always, above your spinal cord injury

• Blurry vision or seeing spots

• Nasal congestion

• Slow pulse (less than 60 beats per minute)

• Restlessness, anxiety or jitters

• A feeling of tightness in your chest, flutters in your heart or chest

• Trouble breathing

• Hypertension (blood pressure greater than 200/100 or 20-40mm Hg higher than normal)

• Flushed face

• Red blotches on the skin above level of injury

• Nausea

• Cold, clammy skin below level of injury

While there may be other warning signs, these are the most common. If any of them appear, or if your blood pressure rises 20-40mm Hg systolic, assume that you have autonomic dysreflexia.

Causes

Anything that would have been painful, uncomfortable or physically irritating before the injury may cause autonomic dysreflexia after the injury. The most common cause seems to be overfilling of the bladder. This could be due to a blockage in the urinary drainage device, bladder infection (cystitis), inadequate bladder emptying, bladder spasms, or possibly stones in the bladder. The second most common cause is a bowel that is full of stool or gas. Any stimulus to the rectum, such as digital stimulation, can trigger a reaction, leading to autonomic dysreflexia. Other causes include skin irritations, wounds, pressure sores, burns, broken bones, pregnancy, ingrown toenails, appendicitis, and other medical complications.

Treatment

Treatment must be initiated quickly to prevent complications.

• Remain in a sitting position but do a pressure release immediately; you may transfer to bed but always keep head elevated to 90 degrees and lower your legs if possible.

• Remove or loosen anything tight such as external catheter tape, clothes, shoes or leg braces, leg bag straps, abdominal binders, elastic hose or bandages, etc.

• Take your blood pressure reading every 5 minutes if you have a blood pressure kit, to see if you're getting better.

• Suspected cause = bladder? Check catheter - remove kinks if found, empty urinary collection bag, irrigate catheter. If catheter is not draining, replace it immediately. If an intermittent catheterization program is in place, a straight catheterization should be performed immediately with slow drainage to prevent bladder spasms.

• Suspected cause = bowel? If episode happens during digital stimulation, stop stimulation until symptoms and signs subside. Consider use of a prescribed anesthetic ointment to suppress the noxious stimulus. If the issue is impacted stool, disimpact. If it occurs while doing a bowel program in bed, try commode-based bowel evacuation. Consider use of abdominal massage instead of digital stimulation.

• Suspected cause = skin? Loosen clothing. Check for source of potential offending stimulus - check for pressure sores, toenail problems, soles of the feet.

• Contact your healthcare provider, even if the symptoms go away. Report the symptoms you've had and what you did to correct the problem. If the symptoms return, repeat these steps. Even if the symptoms go away again, call your healthcare provider and go to an emergency room.

  • At the emergency room, make sure you tell the emergency room staff that you think you may have autonomic dysreflexia and need immediate treatment

  • Ask to have your blood pressure checked immediately

  • Request to keep sitting up as long as your blood pressure is high

  • Ask the emergency room staff to look for causes of the problem: 1) bladder 2) bowel & 3) other causes

  • Suggest that your healthcare provider instill anesthetic jelly into your rectum before checking your bowel

  • Inform the emergency room staff that there is a complete clinical practice guideline available at the web site www.pva.org

Prevention

The following are precautions you can take which may prevent episodes:

• Persons at risk and those close to them should be educated in the causes, signs and symptoms, first aid, and prevention of autonomic dysreflexia

• Frequent pressure relief in bed/chair

• Avoidance of sun burn/scalds (avoid overexposure, use sunscreen, watch water temperatures)

• Maintain regular bowel program

• Well balanced diet and adequate fluid intake - check with your healthcare professional about what the right amount is for you to keep flushing out your bladder without letting it get overfull

• If you suspect that you have a urinary tract infection (UTI) contact your healthcare provider right away

• Do not cut back on fluids for convenience - you'll increase your risk for a UTI

• Compliance with medications

• If you have an indwelling catheter:

  • Keep tubing free of kinks

  • Keep drainage bags empty

  • Check daily for grits (deposits) inside of catheter.

  • If on an intermittent catheterization program, catheterize as often as necessary to prevent overfilling

  • Change your catheter regularly. Learn how to change it yourself or make arrangements for someone to do it for you - train someone who can change it in an emergency

• If individual has spontaneous voiding, make sure there is an adequate output

• Stick to your schedule - don't skip catheterization sessions

• Carry an intermittent catheter kit when away from home

• Perform routine skin assessments

Sources: sci-info-pages, WebMD, SCI Information Network (UAB), Consortium for Spinal Cord Medicine