Autonomic Dysreflexia

a guide for nurses

1. Autonomic Dysreflexia
A guide to acute nursing care
prevention, and education

2. Objectives
After this presentation you should be able to:
Understand what AD is
Know how to manage acute AD crisis
Know some ways to prevent AD
Effectively educate patients on the management
and prevention of AD

3. What is Autonomic Dysreflexia?
An abnormal response to painful stimuli below the level
of Spinal Cord Injury (SCI)
Mediated by the Autonomic Nervous System (ANS)
SCI above T6
Causes dangerous high blood pressure
Emergency!

4. Pathopysiology
http://emedicine.medscape.com/article/322809-
overview

5. Pathophysiology
Painful/noxious stimuli occurs below SCI
Signal is blocked at site of SCI so patient is not
aware of pain and cannot correct it
Autonomic Nervous Stystem responds:
(ANS) ---> vasoconstriction below SCI. Sudden
rise in blood pressure.

6. Pathophysiology
ANS detects high BP above SCI and attempts to correct it:
Bradycardia (vagal nerve)
Vasodilation in head and chest to absorb increased blood flow to upper body
Negative feedback loop is interrupted by the SCI.
Cycle continues until stimulus is removed

7. Causes
#1 cause is a full bladder
#2 cause is a full bowel

8. Causes
bladder or kidney infection
gastric ulcers, gallstones, other GI disturbances
tight clothing, leg braces, shoes
patient lying or sitting on hard object
pressure ulcer
ingrown toenail
insect bites and other minor injuries
DVT

9. Causes
sexual activity
menstruation
pregnancy
vaginal infections
extreme temperatures
rapid changes in temperature
positioning problem, lack of circulation to limb
drug stimulants

10. Signs and Symptoms
Systemic
Rapid rise in systolic and diastolic blood
pressure 20-40 mmHg above patient's
baseline.
Bradycardia
Cardiac arrhythmias, A-fib, PVC, AV conduction
abnormalities

11. Observable Signs
Above SCI site
Profuse diaphoresis
Piloerection
Flusing of skin, especially face, neck, shoulders

12. Symptoms
Patient reports:
severe headache
blurred vision
spots in visual fields
nasal congestion
anxiety, sense of impending doom
* slient AD does not have symptoms despite
signficant elevation in BP

13. Acute Care Nursing Plan Goals
Locate and remove stimuli
Lower blood pressure
Administer prescribed meds
Notify doctor

14. Step-by-Step Care
1. Sit the patient up

15. Step-by-Step Care
2. Loosen restrictive clothing

16. Step-by-Step Care
3. Closely monitor BP

17. Step-by-Step Care
4. Check the Bladder

18. Step-by-Step Care
5. Check the bowels

19. Step-by-Step Care
6. Check for other noxious stimuli
toes up

20. “The Four B's”
Bed Up
Bladder
Bowels
Body

21. Medication
Systolic BP > 150mmHg
Procardia (nefidipine)
immediate release tablets, bite and swallow
Nitrates
nitroglycerin paste
Others: mecamylamine, diazoxide, and
phenoxybenzamine.

22. If Unresolved
If noxious stimuli not identified
and crisis unable to be resolved,
In-patient: call doctor
Home Health: consider admitting
Teach patient: call 911 or go to ED

23. Prevention
Prevention is the key to preventing an autonomic
crisis!
Regular bladder and bowel care
Prevent pressure ulcers
Inspect patient bed often for foreign objects
Check records for past crisis and causes
Avoid tight fitting clothes, changes in temp.

24. Surgical/Outpatient Testing
Prevent Autonomic Dysreflexia
hypothermia
positioning
vein/artery access procedures
Continuously monitor BP for signs of AD!

25. Patient Teaching
AD kit
cath/bowel care
educate family
card with plan of care
medical bracelet

26. References
Paralyzed Veterans of America/Consortium for Spinal Cord Medicine. Acute management of autonomic
dysreflexia: individuals with spinal cord injury presenting to health-care facilities. Washington (DC): Paralyzed
Veterans of America (PVA); 2001 Jul. 29 p.
Autonomic Dysreflexia in Spinal Cord Injury: Treatment & Medication
Author: Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist,
Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics;
Director, NARCOMS Project for Consortium of MS Centers
Glynis Collis Pellat, British Journal of Neuroscience Nursing, Aug/Sept 2010, Vol 6, Number 6, PP 271-275
Autonomic Dysreflexia: What You Should Know, Consortium for Spinal Cord Management. www.pva.org