What to do if AD is suspected

Autonomic dysreflexia (AD) is a potentially life-threatening medical emergency:

• • AD can occur in patients with spinal cord injury at or above the 6th thoracic vertebra (T6).
  • It is more likely to occur in patients with complete injuries, but incomplete injured patients can also be at risk.
  • The condition is triggered by a painful stimulus below the level of the injury which causes severe, sudden hypertension (raised blood pressure),
    and if left untreated can be harmful
  • For most people, AD can be easily treated as well as prevented.
    The key is knowing your baseline blood pressure, triggers and symptoms.

NOTE: Medications are generally used only if the offending trigger/stimulus cannot be identified and removed – or when an episode persists even after removal of the suspected cause.

What to do if AD is suspected:

• • Most importantly, locate and remove the offending stimulus, if possible.
    Early recognition of the condition is essential so that treatment can be started immediately.
  • Begin by looking for your most common causes: bladder, bowel, tight clothing, skin issues.

NOTE: Keep in mind that when you remove the cause, your AD may get worse before it gets better.

Then follow these steps:

1. 1. Sit up or raise your head to 90 degrees
      If you can lower your legs, do so
   2. Loosen or remove anything tight 
   3. Treat the cause 
   4. Not everyone has access to a blood pressure (B/P) machine but if you can, check blood pressure every five minutes.
      NOTE: It is more important to treat the cause first when you are dysreflexic, than trying to get a blood pressure reading.
      In adults with a cervical level (neck) injury who often have low blood pressure, a rise in systolic (upper) blood pressure of 20 – 40mmHg (which may bring your B/P within the normal range) may indicate AD.
      For other patients a systolic (upper) B/P of 150mmHg or more is an indicator of AD.
      Make sure you know YOUR normal resting blood pressure  (see below*)
   5. Stay sitting up until blood pressure is normal

Seek prompt medical advice if the cause cannot be identified, or the hypertension cannot be controlled.

Tell the doctors and nurses/paramedics/ambulance crew that you:

1. 1. may have Autonomic dysreflexia (AD)
   2. need to find what’s causing it
   3. need to have your blood pressure checked
   4. need to stay sitting up

NOTE: If the hypertension is severe, or the cause still cannot be identified, you will need to be treated with medication.

Medications are generally used only if the offending trigger/stimulus cannot be identified and removed – or when an episode persists even after removal of the suspected cause.

Medication

Medications are generally used only if the offending trigger/stimulus cannot be identified and removed – or when an episode persists even after removal of the suspected cause.

You or your carer must carry medication and other supplies to treat the causes of AD at all times.

• Medicines that can be used include nifedipine capsules, glyceryl trinitrate (GTN) tablets or spray, and captopril.
• (If you use medication to treat erectile problems GTN may not be suitable for you to use as it lowers the B/P further).
• Your doctor and pharmacist will advise you what dose should be taken and how to give the medicine.
• Check regularly that your medication is not out of date.

If medicines have been taken, continue to monitor B/P (if you can), pulse rate and symptoms (* See below for more information)

• every 5 minutes until B/P returns to normal
• then every 15 minutes for 1 hour.

* Know your normal resting blood pressure

• It is important that you are aware of, and have written down your normal resting blood pressure.
• This will help to identify whether your blood pressure is higher than normal for you.

The following blood pressure readings may be a sign of autonomic dysreflexia (* Hg is chemical sign for mercury and how B/P is measured):

20mmHg to 40mmHg above baseline in adults

15mmHg above baseline in children

15mmHg to 20mmHg above baseline in adolescents

Signs of AD

Some of the signs of AD include:

• high blood pressure
• pounding headache
• flushed face
• sweating above the level of injury
• goose flesh below the level of injury
• nasal congestion
• nausea
• a slow pulse (slower than 60 beats per minute)

Some causes of AD

Autonomic Dysreflexia is caused by an irritant below the level of injury, often related to bladder or bowel, such as:

• irritation of the bladder wall, urinary tract infection, blocked catheter or overfilled collection bag or full bladder
• distended or irritated bowel, constipation or impaction, haemorrhoids

Other causes include:

• skin problems, pressure ulcers, ingrown toenails
• burns (including sunburn or hot objects and scalds from hot water)
• tight or restrictive clothing
• AD can also be triggered by sexual activity, menstrual cramps, labour and delivery, ovarian cysts
• abdominal conditions (eg gastric ulcer, colitis, inflammation of the gallbladder or appendicitis )
• bone fractures or sprains