Management

There is a well-established protocol for the management of AD developed by the Consortium for Spinal Cord Medicine (Consortium for Spinal Cord Medicine 1997). In patients with spinal cord injury, appropriate bladder and bowel routines, in addition to pressure sore prevention are the most effective measures for the prevention of autonomic dysreflexia. However, for each individual, the identification and elimination of specific triggers for autonomic dysreflexia should also be employed to manage and prevent episodes of autonomic dysreflexia (Teasell et al. 2000; Mathias & Frankel 2002; Blackmer 2003).

There is growing evidence that education on knowledge and management of this life-threatening condition is crucial for both medical personnel and individuals with SCI (McGillivray et al. 2009).

When AD develops, the initial management of an episode involves placing the patient in an upright position to take advantage of an orthostatic reduction in blood pressure, and the loosening of any tight clothing (Consortium for Spinal Cord Medicine 1997). Throughout the episode, the blood pressure should be checked at 5 minute intervals. It is then necessary to search for and eliminate the precipitating stimulus where one can be identified, most commonly (in 85% of cases) related to either bladder distension or bowel impaction (Teasell et al. 2000; Mathias & Frankel 2002). The use of antihypertensive drugs should be considered as a last resort, but may be necessary if the systolic blood pressure remains at 150mmHg or greater following the steps outlined above (Consortium for Spinal Cord Medicine 1997). The goal of such an intervention is to alleviate symptoms and avoid the complications associated with uncontrolled hypertension (Yarkony et al. 1986; Pine et al. 1991; Eltorai et al. 1992; Valles et al. 2005).

The identification of the possible trigger and a decrease of afferent stimulation to the spinal cord is the most effective prevention strategy in clinical practice.