Episode 15- Autonomic Dysreflexia
 
What is it?

Excessive autonomic nervous system activity triggered by afferent stimuli below the level of the spinal cord injury (usually level T6 and above)

The stimulus can be noxious or non-noxious
Usually it is a noxious stimulus
Example: kinked catheter, tight clothing, overheating, UTI, bowel impaction, skin irritation

Need to realize that the patient does not have sensation at this level, so their body is telling them that something is wrong via AD/excessive ANS activity and you as the PT need to figure out what is causing this response

 
Anatomy

Know what level it can occur at (T6 level of injury and above)
Noxious/non-noxious stimuli

 
Differential Diagnosis

Orthostatic hypotension: presents similarly, check BP! OH: BP drops, AD: BP stays the same or is rising
Migraine: a lot of reports from patients involve a pounding headache
Essential hypertension: a person is becoming hypertensive with a certain activity
Anxiety
Withdrawal from pharmacologic drugs

 
Special tests

BP
Clinical diagnosis: look at the signs & symptoms

Signs: very rapid increase in BP (doesn’t always increase, but if it does, it will be rapid), decreased heart rate, goosebumps, diaphoresis, flushed skin above the level of the injury
Symptoms: pounding headache, chills, anxiety, nausea

 
How it will look on the test:

Incorporating a patient with a SCI and identifying AD and knowing how to manage it, what level injuries it may occur with
How to manage: sit the patient up! (the direct opposite of orthostatic hypotension), quickly identify what the irritant is

Fun way to remember how to treat immediately:

AD: BP up, sit the patient up
OH: BP down, lay patient down