What is autonomic dysreflexia, which patients are at risk, and initial management steps?

• A. Autonomic dysreflexia is a slow, benign syndrome in spinal cord injury.
• B. It is triggered by severe hypotension in patients with SCI above T6.
• C. Acute dangerous hypertension triggered by stimuli in patients with SCI above T6; management: sit patient upright, remove triggers, monitor BP; treat persistent hypertension per protocol.
• D. It only occurs in head injuries.

Answer: (C)

Autonomic dysreflexia occurs in people with spinal cord injuries at or above the T6 level. A noxious or sensory stimulus below the injury—such as bladder overdistension, bowel impaction, a kinked catheter, a tight belt, or skin irritation—triggers a sudden, unregulated sympathetic response that causes acute, potentially life-threatening hypertension. The patient may also have headache, sweating, flushing above the level of injury, and a slowed heart rate.

The immediate management focuses on removing the stimulus and reducing the blood pressure. Sit the patient upright to use gravity to lower BP, then identify and eliminate the triggering factor—check for bladder issues (urinary retention or catheter obstruction) and ensure the bladder is emptied, assess for bowel distension, and remove any tight clothing or devices. Continuously monitor blood pressure, and if hypertension persists despite removing triggers, administer antihypertensive treatment per protocol. This approach prevents severe complications while addressing the underlying cause.