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Autonomic Dysreflexia

Autonomic dysreflexia can occur in persons with a spinal cord injury (SCI) above T6. This can be life threatening because of elevated blood pressure.

Signs and Symptoms

High blood pressure; severe/pounding headache; goose bumps above level of injury, sweating above level of injury; flushing or pallor; stuffy nose; nausea or vomiting; “not feeling right”.

Common Causes

Full bladder, full bowel, skin sore, ingrown toenail, irritation or tight clothing, but could be anything that would have caused pain below level of injury prior to injury.


Check Blood pressure

Sit up as straight as possible, remove abdominal binder or any other tight clothing (e.g., TED Hose, shoes)

Check bladder

Indwelling catheter (foley, suprapubic):

  • Check all tubings for kinks or a full bag
  • Flush catheter. If nothing returns or if unable to flush, then change catheter

Intermittent catheter program:

  • Catheterize immediately

Check bowel for fullness:

  • Insert xylocaine jelly into rectum
  • Gently remove stool, if present

Check skin for sores, ingrown toenails, trauma (broken bone or severe cut). Tests and procedures can also trigger Autonomic Dysreflexia (cysto, gynecology exam).

If above treatments fail to bring BP down:

  • Go to the nearest emergency room
  • Give them this information
  • This hypertension should be treated medically

Apply nitroglycerine paste 1 – 2 inches to skin every 2 hours. May wipe off if blood pressure is stable. Reapply if needed. Nifedipine 10 mg capsule (immediate release form). May repeat in 20 – 30 minutes, if necessary. Avoid sub-lingual, which can cause abrupt hypotension.

Check blood pressure at least every 3 minutes. It can change rapidly.

► Download autonomic dysreflexia information sheet
► Download autonomic dysreflexia alert card

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