Autonomic dysreflexia (AD) is a medical emergency in patients with neurogenic bladder and spinal cord injury at the neurologic level T6 or above. When blood pressure rises sharply and classic symptoms persist, immediate structured intervention is required.
This protocol applies to patients with SCI at T6 or above who develop autonomic dysreflexia with systolic blood pressure greater than 150 mm Hg or 20 mm Hg above baseline and persistent classic symptoms — including flushing, sweating, headache, blurry vision, and a sense of impending doom — indicating inadequate management.
Immediate management begins with terminating any inciting procedure and urgently draining the urinary bladder — the complete protocol details further critical steps for hemodynamic stabilisation.
Systolic blood pressure returning to baseline with stable vital signs.
AD is a medical emergency specific to patients with SCI at the neurologic level T6 or above.
Patients with a systolic blood pressure greater than 150 mm Hg and/or 20 mm Hg above baseline who exhibit persistent classic symptoms such as flushing, sweating, headache, blurry vision, and a sense of impending doom are not adequately managed.
For the NLUTD patient who develops autonomic dysreflexia during urodynamic testing and/or cystoscopic procedures, clinicians must terminate the study, immediately drain the bladder, and continue hemodynamic monitoring.
Initial management also involves placing the patient in an upright position in a wheelchair to take advantage of any orthostatic reduction in blood pressure and loosening tight clothing and/or constrictive devices.
Blood pressure should be monitored at least every five minutes until the patient is stable with baseline vital signs.
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