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Non-Pharmacological Treatments for AD

Mr. CM’s episodes of autonomic dysreflexia are increasing in frequency and intensity. The blood pressure during one episode increases to well over 200 mmHg systolic and is persisting. Episodes are occurring more frequently than ever.
What non-pharmacological management is available to treat AD once it has developed?
See Figure 5

1. Recognition of symptoms and removal of painful stimuli.
2. With elevated blood pressure, the person should be sat up and constrictive devices loosened or removed. These can include all tight clothing, abdominal binders and anti-embolic stockings.
3. Blood pressure should be monitored every 2 – 5 minutes until stabilized.
4. Rapid survey for instigating causes is begun with the urinary system
5. Individual should be catheterized after inserting 2% lidocaine jelly into the urethra and waiting 2 minutes.
6. An existing catheter system should be checked for kinks, folds, constrictions or obstructions and for correct placement.
7. A blocked catheter should be irrigated with a small amount of fluid such as saline at body temperature.
8. If blood pressure is at or above 150 mm Hg, pharmacological management should be considered.
9. If blood pressure is elevated but below 150 mm Hg, then fecal impaction should be checked at the rectum.
10. The individual’s symptoms and blood pressure should be monitored for at least 2 hours after resolution.

For more information, please see: Non-pharmacological treatments for Autonomic Dysreflexia

Figure 5. Non-pharmacological management to treat autonomic dysreflexia once it has developed