Actionable Nuggets for SCI (2nd ed., 2013)
Alert patients with SCI at T6 and above to the risks of Autonomic Dysreflexia, and the need for urgent treatment at the onset of an episode.
Autonomic Dysreflexia (AD) is a potentially life threatening condition that affects people with SCI lesions at or above T6. Signs and symptoms of AD include sudden hypertension (an increase in systolic BP greater than 20-40 mmHg), headache, and bradycardia. Untreated AD may result in intracranial hemorrhage, retinal detachment, seizure and death.
Evidence-based Best Practice:
The vast majority of cases of AD are related either to bladder distension or bowel impaction, but AD has also been associated with skin irritation, sexual activity, or other systemic issues. AD occurs when reflex sympathetic activity below the lesion triggers corresponding parasympathetic vagal activity above the lesion.
Resting BP typically declines after a spinal cord injury, often to about 90/60 mmHg; thus readings of 120/80 mmHg might be considered elevated. Resting BP should be monitored as a baseline.
Management of episodic AD should be treated as a medical emergency:
- Place the patient in an upright position
- Loosen clothing and other restrictions
- Monitor pulse and BP every 2-5 minutes during the episode.
- Search for and eliminate the precipitating stimulus (eg., bowel or bladder emptying).
- If systolic BP remains at or above 150 mmHg, consider rapid-onset, short duration anti-hypertensives, such as nifedipine, nitrates, and captopril
- Continue to monitor BP for at least 2 hours after symptoms resolve, and consider admission if symptoms persist.
AD affects >50% of patients with SCI lesions above T6. AD is three times more prevalent with a complete injury. AD is more severe in patients with higher lesions and more complete lesions. A recent study found that 41% of SCI patients had not heard of AD, and 22% reported symptoms consistent with unrecognized AD.
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