Autonomic Dysreflexia : What Do I Do Now ?

There are approximately 250,000 Americans currently living with spinal cord injury (SCI) and an estimated 11,000 new injuries occur annually.  Individuals with SCI at the thoracic level T6 or above are usually at risk of developing Autonomic Dysreflexia (AD), also known as autonomic hyperreflexia.   Prevalence estimates vary from 66 to 85% of patients with lesions at or above T6 after spinal shock is over, so AD may be seen in the hospital or home. 

AD is caused by a variety of stimuli, creating an exaggerated response of the sympathetic nervous system (massive vasoconstriction) due to lack of control from higher centers above the injury.  Common symptoms include a sudden increase in blood pressure, pounding headache, bradycardia, profuse sweating and flushing of the skin above the injury, blurred vision, dilated pupils, piloerection below the level of injury, and nasal congestion.  These symptoms must be recognized and treated quickly to prevent life threatening complications such as seizure, acute myocardial infarction, or cerebral hemorrhage. 

The most common causes of AD include bladder distention/obstructed catheter, bladder or kidney stones, urologic instrumentation, bowel distention/impaction, pain, and pressure ulcers.  These are all areas within the scope of practice of the WOCN.

Fortunately, the Consortium for Spinal Cord Medicine has developed a clinical practice guideline that provides recommendations and supporting evidence in the management of AD.  The WOCN may use these guidelines in the management of the SCI patient, and when providing education to the patient and family since they must also be taught to recognize the symptoms of AD, and to either take action or instruct caregivers to take actions.

This poster will review the development of the SCI clinical practice guidelines for AD, some of the specific recommendations and evidence related to bladder and bowel interventions, evaluation of outcomes, and ultimately prevention of AD.