Autonomic Dysreflexia

AUTONOMIC DYSREFLEXIA IS A MEDICAL EMERGENCY! – You need to recognize it and get the right care fast.

 Autonomic Dysreflexia can be life-threatening. It requires quick and correct action. Unfortunately, many health professionals aren’t familiar with this condition. That’s why it’s important for you, the people close to you and personal care attendants, to learn about it. You may have to help guide your own treatment by ensuring that health-care professionals are thinking about Autonomic Dysreflexia when they are treating you.

 

It’s a good idea to keep Autonomic Dysreflexia information close by and carry an AD carry card (available from MDSIA), you may want to take them with you to the hospital and share it with the emergency room staff

Autonomic Dysreflexia (AD) can occur in persons with a spinal cord injury at or above the T6 level.  AD happens when there is an irritation, pain, or stimulus to the nervous system below the level of injury. The irritated area sends a signal to the brain but it is not able to reach the brain. A reflex action takes place, tightening blood vessels, causing the blood pressure to rise. If the high blood pressure is not controlled it may cause a severe headaches, seizures,  stroke, and even  death.

Signs or Symptoms

  • high blood pressure
  • seeing spots or blurred visions
  • pounding headache
  • nasal stuffiness
  • flushed face
  • red blotching on chest
  • sweating above level of injury
  • goose bumps
  • cool, clammy skin
  • nausea
  • feeling anxious / a feeling of “impending doom”

Causes

Anything that would have been painful, uncomfortable, or physically irritating before the injury may cause Autonomic Dysreflexia after the injury.

The most common causes seem to be overfilling of the bladder or bowel that is full of stool or gas.

Bladder (most common) – from overstretch or irritation of bladder wall
Urinary tract infection
Urinary retention
Blocked catheter
Overfilled collection bag
Non-compliance with Catheterisation program

Bowel – over distension or irritation
Constipation / impaction
Distension during bowel program (digital stimulation)
Haemorrhoids or anal fissures
Infection or irritation (eg. appendicitis)

Less common causes

Skin-related Disorders
Any direct irritant below the level of injury (eg. – prolonged pressure by object in shoe or chair, cut, bruise, abrasion)
Pressure sores
Ingrown toenails
Burns (eg. – sunburn, burns from using hot water)

Wounds

Skin irritations
Tight or restrictive clothing or pressure to skin from sitting on wrinkled clothing

Sexual Activity
Over stimulation during sexual activity (stimuli to the pelvic region which would ordinarily be painful if sensation were present)
Menstrual cramps
Labour and delivery

Other
Acute abdominal conditions (gastric ulcer, colitis, peritonitis)
Skeletal fractures / Broken bones

 Prevention

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

  • Keeping your catheter equipment clean and draining freely;
  • Emptying your bladder routinely;
  • Following a regular bowel program;
  • Checking skin daily;
  • Wearing loose fitting clothing
  • Check for painful stimuli and removing.
  • Frequent pressure relief in bed/chair
  • Avoidance of sun burn/scalds (avoid overexposure, use of 15 or greater sunscreen, watch water temperatures)
  • Well balanced diet and adequate fluid intake
  • Compliance with medications
  • People at risk and those close to them should be educated in the causes, signs and symptoms, first aid, and prevention of Autonomic Dysreflexia.

Treatment

Ask others to call for an Ambulance urgently, or call one yourself. Have information on AD instantly available

Short-acting Glyceryl nitrate (Nitrolingual spray, 1 -2 puffs under tongue immediately and repeat every 5 mins till symptoms reduce (beware, this spray can also cause headaches

Your Spinal injuries Doctor may prescribe special, or similar medication that is longer acting

AUTONOMIC DYSREFLEXIA IS A MEDICAL EMERGENCY!

You need to recognize it and get the right care fast.

Autonomic Dysreflexia can be life-threatening. It requires quick and correct action. Unfortunately, many health professionals aren’t familiar with this condition. That’s why it’s important for you, the people close to you and personal care attendants, to learn about it. You may have to help guide your own treatment by ensuring that health-care professionals are thinking about Autonomic Dysreflexia when they are treating you.

It’s a good idea to keep Autonomic Dysreflexia information close by and carry an AD carry card (available from MDSIA), you may want to take them with you to the hospital and share it with the emergency room staff.