• this is a medical emergency
  • most common sources are bowel and bladder
  • most common injury levels at risk are T6 and rostral
  • pounding headache
  • hypertension
  • profuse sweating and flushing above the level of injury
  • blurry vision
  • sudden rise in BP generally greater than 20 mmHg (trend baseline)
  • bradycardia
Risk Factors
  • injuries T6 and higher
  • complete injuries
  • Sit patient upright
  • Loosen clothing
  • Relieve obstruction to drainage of an indwelling urinary catheter. If no indwelling catheter present then catheterize
  • If the systolic blood pressure is still 150 mmHg or greater administer rapidly acting and easily reversible antihypertensives such as nitropaste
  • If the systolic blood pressure is less than 150 mmHg then the rectum should be manually disimpacted
  • Search for other precipitants if symptoms persist
  • Consider using lidocaine jelly before bowel routine if AD triggered by bowel routine
  • References

    Garstang SV WH. Spinal Cord Medicine. Kirshblum S. C, D, editor. 2nd ed.: LWW; 2011. Chapter 9, Cardiovascular and autonomic dysfunctions after spinal cord injury. p.136-154.

    Kirshblum S, Nieves J, Clark D, Gonzalez P, Cuccurullo SJ, Luciano L. Physical Medicine and Rehabilitation Board Review. Cuccurullo SJ LJ, editor. 3 rd ed. New York, NY: Demos Medical; 2015. Chapter 7, Spinal cord injuries. p.551-620.

    Partida E, Mironets E, Hou S, Tom VJ. Cardiovascular dysfunction following spinal cord injury. Neural Regen Res 2016 Feb;11(2):189-194.