What is Autonomic Dysreflexia?
Autonomic Dysreflexia (AD) is the abnormal response of the autonomic nervous system resulting in the occurrence of excessive high blood pressure as a result of some sort of noxious (painful) stimuli below the level of the injury in those with a spinal cord injury. It is most common in those who have an injury at the level of T6 and above.
This is a medical emergency and if your patient starts to exhibit signs and symptoms associated with AD you should call 911 immediately!
What is happening to the body when AD occurs?
The body has two components of the autonomic nervous system: sympathetic and parasympathetic. The sympathetic component is known as the fight or flight mechanism. It is responsible for increasing heart rate, constricting blood vessels to shunt blood to the organs in need, and raising blood pressure. The parasympathetic component is known as the rest and digest mechanism. It is responsible for slowing down the heart rate, increasing intestinal activity for digestion, and relaxing the sphincter muscles. When there is a stimulus in the body that would be painful or uncomfortable, the nerve sends an impulse to the brain. The sympathetic nervous system would be activated in order to speed up your blood pressure, which then slows down the heart rate. However, since there has been a disruption between the two nervous systems as a result of the injury, this communication is interrupted and the sympathetic component is highly reactive to a stimulus while the parasympathetic component cannot counteract the reaction. As a result blood pressure goes unregulated.
What are common signs & symptoms?
Flushed appearance to the face
Excessive sweating above the level of the injury
Nausea, dizziness, lightheadedness
Slow heart rate
Cold, clammy skin below the level of the injury
What are some triggers?
Full bowel or bladder
Urinary tract infections
Pressure sores, burns, blisters
Broken bones or heterotopic bone
Extreme temperature or fluctuations
Deep vein thrombosis, pulmonary embolism
How can we avoid these triggers?
Bowel or bladder programs
Consistent checking of catheters
Regular skin checks
Proper skin care
Appropriate clothing that are not too tight
What to do if my patient shows signs of AD?
Try to quickly identify cause of the noxious stimuli and remove it if at all possible. Check to see if the bowel/bladder has been emptied or if the bags are too full. Check to see if the patient is sitting or lying on a sharp or uncomfortable item. Remove tight clothing immediately. Sit the patient up and raise their head. Call 911 immediately because this is a medical emergency.
If the patient is not attended to in an appropriate fashion, AD can lead to seizures, stroke, or death.