Autonomic Dysreflexia Treatment Algorithm

Symptoms and signs of Autonomic Dysreflexia

Ask patient and carer if they suspect a cause

(if so, direct initial attention there)

Monitor BP for 1hr Check Blood Pressure (BP)

Contact Spinal Is BP ≥20mmHg above resting level ?
Unit for Specialist NO (NB. BP in tetraplegia typically 90-110/60-70mmHg lying
advice and commonly lower still sitting!)

YES
If systolic BP increases Request assistance from another person
≥20mmHg above resting
level? NOTE. THIS IS A MEDICAL EMERGENCY!
Monitor BP & pulse rate (every 2-5 mins), until settled
Sit up patient (and lo wer legs, if possible)
Loosen any tight clothing/leg straps
Remove TEDS/abdominal binder
Check for kinked tubing,
overfull leg bag or
blocked catheter Does person have an indwelling urethral
YES
Estimate volume in leg or suprapubic catheter?
bag; compared with fluid
intake & usual urine
drainage pattern NO

No
Is catheter draining Check BP before proceding
(IDC/SPC
satisfactorily? Is systolic BP ≥170mmHg? NO
is blocked)

YES
YES NO

Administer 1 Nitrolingual spray OR _

Anginine tablet under tongue. If GTN
If IDC/SPC appears (Dose can be repeated in 5-10 mins). contraindicated or
blocked, irrigate
unavailable, swallow
catheter gently with no WARNING: DO NOT USE GTN SPRAY OR 1 crushed 10mg
more than 30mls of TABLETS IF SILDENAFIL (VIAGRA) HAS Nifedipine
normal saline BEEN TAKEN IN LAST 24 HOURS! (Adalat) tablet.

Insert generous amount of Xylocaine (2%

No drainage anaesthetic) gel into urethra; wait 3-5 mins
with irrigation and pass/replace catheter

If bladder full, drain 500mls initially; then ~250mls every 15 mins.

Perform urine dipstick; send specimen for microscopy
and culture if suspect UTI
Treat with appropriate antibiotics
Insert generous amount of
Monitor BP for 4 hours if BP initially Xylocaine (2% anaesthetic) gel
falls to ensure no recurrence. into rectum; wait 3-5 mins,
YES Is BP settling down? NO
If symptomatic hypotension, then perform gentle PR exam
lay person down & elevate legs

Undertake systematic survey for other If rectum is full and

causes of nociception (eg. epididymo- Rectum systolic BP <150mmHg,
If recurrence with catheter draining, instill orchitis, pressure sores, burns, ingrown empty perform manual evacuation
10 ml of 10% Xylocaine for injection toenail, fracture).
into bladder and clamp for 5 mins.
Commence anticholinergic medication If systolic BP ≥150mmHg (or
(eg. Ditropan) AD worsens with disimpaction
If BP not settling promptly or cause not identified,
STOP immediately).
admit to hospital for BP control & investigation.
Take 10mg Nifedipine tablet,
Intravenous medication may be necessary
wait 20 mins & perform manual
Contact Spinal Unit for Specialist advice
evacuation (again).
Project funded by the Motor Accidents Authority of NSW