Autonomic Dysreflexia is a condition that occurs in patients with a spinal cord injury of T6 and above (but has been seen in patients with injuries in T7-T10). It can be life threatening and its vitally important for any caregiver to understand the signs of Autonomic Dysreflexia so serious problems can be avoided.
The way I usually define this condition for laymen is “high blood pressure that can cause seizures, stroke or even death.” I don’t want to scare you but if you work with an individual with a spinal cord injury of T6 and above this information could save your client’s life.
What Are The Signs Of Autonomic Dysreflexia?
Below you will find the main signs of AD. It could be one of these or a combination so make sure that you are aware of each of them.
- Hypertension (high blood pressure)
- Pounding Headache
- Bradycardia (slow heart rate)
- Nasal Congestion
- Cool Clammy Skin
- Chills Without Fever
- Sweating Above Level of Injury
- Skin Flushing Above Level of Injury
- Goose Bumps Above Level of Injury
If you notice that your client has any of the above signs it should cause a red flag to go off in your mind. You should be thinking, “I need to check to see if this is Autonomic Dysreflexia before it gets worse.” So what do you do? In short, find the cause.
4 Main Causes of Autonomic Dysreflexia
Often times the bladder can be a cause of AD. If the bladder is stretching due to (a) a plugged or kink in the catheter, (b) urine retention (for some reason the urine may not be going into the catheter, possibly because of misplacement) or (c) overfilled leg bag. Bladder infection could also cause AD in the client.
Another cause of Autonomic Dysreflexia could be from a stretching of the bowel from constipation or impaction. That’s why its so important to be regular, especially if you have a spinal cord injury.
Burns or skin sores can cause AD as well as ingrown toenails and tight clothes that cause an irritating pressure.
4. Sexual Activity
Over stimulation from sexual activity can be a cause too as well as contractions of the uterus before and during menses (female) and labor & delivery (obviously female too.)
Step-by-Step Process for Treating Autonomic Dysreflexia
There are 6 main ways to treat Autonomic Dysreflexia and they all stem from one overarching theme: find out the cause and remove it. In a nutshell, here they are:
Step 1 – Sit Up
If your client is laying down, have them immediately sit up. Remember that we are trying to avoid extreme blood pressure in the head so this will help the blood flow downward.
Step 2 – Identify & Remove the Source of Irritation
This may seem obvious but remember that the entire goal is to locate the problem area and remove it. So it bares repeating here.
Step 3 – Check the Bladder
This step includes checking the catheter, removing any kinks in the catheter, emptying the catheter, irrigating it if its not draining and changing it.
Step 4 – Check the Bowel
The best way to check the bowel in the home care setting is by a digital check (that means your finger). If you find any stool in the bowel remove it.
Step 5 – Check the Skin
Clothing can easily be a culprit if it is too tight. Loosen any clothing they may have on and check for pain or pressure.
Step 6 – Call the Doctor
If the signs continue (such as high blood pressure) call the doctor immediately and let him/her know what is going on. You will be told what next steps to take.
How To Prevent Autonomic Dysreflexia
The following action steps are preventative measures that you can use to possibly prevent AD from occurring in the first place.
- Keep catheter equipment clean.
- Follow a regular bladder program.
- Follow a regular bowel program (It’s important to never go longer than 3 days between bowel programs.).
- Check skin daily (Look for pressure areas and have your client wear loose-fitting clothing.).
- Check for painful stimuli.
I hope this article has given you some resources for checking and treating Autonomic Dysreflexia. Remember that the most important precaution you can make is to have the knowledge of what AD is and what you can do if the signs of Autonomic Dysreflexia show their ugly head.