During autonomic dysreflexia, which positioning is recommended as an initial step?

• A. Sit the patient upright.
• B. Place in supine position.
• C. Place in prone.
• D. Trendelenburg.

Answer: (A)

In autonomic dysreflexia, a dangerous surge of sympathetic activity below a high spinal cord injury causes a rapid rise in blood pressure. The first step is to sit the patient upright. Raising the torso uses gravity to shift blood away from the central circulation, lowering venous return and reducing blood pressure quickly. This helps protect cerebral circulation and buys time to identify and relieve the triggering stimulus, such as bladder distention or stool impaction, and to remove tight clothing or other noxious stimuli.

Other positions aren’t helpful: lying flat (supine) or head-down (Trendelenburg) tends to worsen the hypertensive crisis by increasing cerebral perfusion pressure and systemic vascular resistance. The prone position does not effectively reduce BP and can complicate airway management.