Autonomic Dysreflexia

Question 1

Do patients with resolved symptoms of autonomic dysreflexia require transport to hospital?

Answer 1

Yes, as it is a medical emergency that required identification of probably cause and treatment in hospital to prevent cerebrovascular catastrophe

Question 2

Recite the CPG for autonomic dysreflexia

Answer 2

Question 3

What is autonomic dysreflexia?

Answer 3

It is a syndrome of massive imbalanced reflex sympathetic discharge occurring in patients with an existing, non-acute spinal cord injury above the level of T6

Question 4

What can autonomic dysreflexia be caused by?

Answer 4

• distended bladder due to blocked/kinked catheter
• UTI
• bowel irrigation (constipation/faecal impaction)
• skin irritations (pressure sores, ingrown toe nails, burns, sunburn)
• Contracting uterus
• fractures or any other event that would be normally deemed painful

Question 5

What is the goal of treatment for autonomic dysreflexia?

Answer 5

Removal of the noxious stimuli is the preferred management, however this can be difficult in the pre-hospital environment. Symptomatic management to prevent cerebrovascular catastrophe and other complications is more often the primary goal

Question 6

What are the complications of Autonomic dysreflexia?

Answer 6

occur due to sustained, severe peripheral hypertension

and include:

• cerebral haemorrhage
• myocardial infarction
• seizures

Question 7

What are some clinical features of Autonomic Dysreflexia?

Answer 7

• relative hypertension (BP for quadriplegics and high level paraplegics is typically low when lying and even lower when sitting (SBP >90-100 may be significant)
• flushing of skin above the level of injury or paleness below the level of injury
• bradycardia
• profuse sweating and piloerection above the level of injury
• pounding HA (worsening as BP rises)
• blurred vision, headache, CVA/TIA sx
• ACS
• anxiety and apprehension
• irritability/combative behaviour in people with limited cognition/communication ability