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Treatment Algorithm For Autonomic Dysreflexia (Hypertensive Crisis) in Spinal Cord Injury

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HAYME THARRIS

This treatment algorithm provides guidance on diagnosing and treating autonomic dysreflexia (hypertensive crisis) in patients with spinal cord injuries. The three main steps are: 1) Check for signs and symptoms of autonomic dysreflexia and look for potential causes like bladder distension or constipation. 2) Monitor the patient's blood pressure and look for a 20mmHg or higher increase from their resting level. 3) If blood pressure is elevated, follow the treatment steps to address potential causes and lower blood pressure through measures like catheterization, bowel management, loosening tight clothing, and medication if needed.

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Treatment Algorithm For Autonomic Dysreflexia (Hypertensive Crisis) in Spinal Cord Injury

Uploaded by

HAYME THARRIS
144 views1 page
This treatment algorithm provides guidance on diagnosing and treating autonomic dysreflexia (hypertensive crisis) in patients with spinal cord injuries. The three main steps are: 1) Check for signs and symptoms of autonomic dysreflexia and look for potential causes like bladder distension or constipation. 2) Monitor the patient's blood pressure and look for a 20mmHg or higher increase from their resting level. 3) If blood pressure is elevated, follow the treatment steps to address potential causes and lower blood pressure through measures like catheterization, bowel management, loosening tight clothing, and medication if needed.

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This treatment algorithm provides guidance on diagnosing and treating autonomic dysreflexia (hypertensive crisis) in patients with spinal cord injuries. The three main steps are: 1) Check for signs and symptoms of autonomic dysreflexia and look for potential causes like bladder distension or constipation. 2) Monitor the patient's blood pressure and look for a 20mmHg or higher increase from their resting level. 3) If blood pressure is elevated, follow the treatment steps to address potential causes and lower blood pressure through measures like catheterization, bowel management, loosening tight clothing, and medication if needed.

Copyright:

© All Rights Reserved
Download as PDF, TXT or read online from Scribd
Download as pdf or txt
144 views1 page

Treatment Algorithm For Autonomic Dysreflexia (Hypertensive Crisis) in Spinal Cord Injury

Uploaded by

HAYME THARRIS
This treatment algorithm provides guidance on diagnosing and treating autonomic dysreflexia (hypertensive crisis) in patients with spinal cord injuries. The three main steps are: 1) Check for signs and symptoms of autonomic dysreflexia and look for potential causes like bladder distension or constipation. 2) Monitor the patient's blood pressure and look for a 20mmHg or higher increase from their resting level. 3) If blood pressure is elevated, follow the treatment steps to address potential causes and lower blood pressure through measures like catheterization, bowel management, loosening tight clothing, and medication if needed.

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Safety Notice 014/10

Treatment Algorithm for Autonomic Dysreflexia


(Hypertensive Crisis) In Spinal Cord Injury
Symptoms and signs of Autonomic Dysreflexia
ASK PERSON AND CARER IF A CAUSE IS SUSPECTED
(Common causes to exclude first are:
1. Bladder Distension, 2. Constipation).

Monitor BP for 1hr


Contact Spinal Unit for
specialist advice if required

Check Blood Pressure (BP)


Is BP 20mmHg above resting level ?
(NB BP in a person with tetraplegia or high paraplegia is
typically low e.g. 90-100/60mmHg)

NO

If systolic BP
increases 20mmHg
above resting level?

Check for kinked tubing,


full leg bag or
blocked catheter
Estimate volume in leg bag;
compare with fluid intake &
usual urine drainage pattern

Request assistance from


another person

YES

WARNING:
BEFORE ADMINISTERING ANY
ANTI-HYPERTENSIVE MEDICATION,
ALWAYS CHECK FOR RECENT USE
OF MEDICATION FOR ERECTILE
DYSFUNCTION.

NOTE : THIS REQUIRES IMMEDIATE INTERVENTION


Monitor BP & pulse until symptoms have resolved
Sit person upright and lower legs, if possible
Loosen any tight clothing/leg straps
Remove compression stockings/abdominal binder

By indwelling
urethral (IDC)
or suprapubic
catheter (SPC)

DO NOT USE GLYCERYL TRINITRATE


SPRAY, TABLETS OR PATCH
IF SILDENAFIL (VIAGRA) OR
VARDENAFIL (LEVITRA)
HAS BEEN USED IN LAST 24
HOURS OR TADALAFIL (CIALIS) HAS
BEEN TAKEN WITHIN LAST 4 DAYS!

CHECK FOR BLADDER DISTENSION


How does person empty bladder?

MONITOR FOR HYPOTENSION

By intermittent self-catheterisation, reflex or


'spontaneous' voiding

Is catheter draining
satisfactorily?

YES

NO

IDC/SPC
is blocked
Irrigate catheter
gently with
no more than
30mls of
normal saline

Is catheter
now draining?

Check BP before proceeding. Is systolic BP 170mmHg?

Is glyceryl trinitrate contra-indicated


or unavailable?

YES

NO

Administer 1 Nitrolingual spray OR


Anginine tablet ( tablet in children
between 12-16 years) under tongue.
Dose can be repeated in 5-10 mins.

NO

Insert generous amount of lignocaine 2%


(topical anaesthetic) gel into urethra;
wait 3-5 mins and pass/replace catheter

NO

YES

If the bladder is overdistended, drain 500mls initially,


then 250mls every 10-15 mins to avoid hypotension.

Monitor BP for 4 hours to


ensure no recurrence
- if symptomatic hypotension,
lay the person down and
elevate legs
- IF SYMPTOMS RECUR
CONTACT A SPINAL
PHYSICIAN URGENTLY

YES

NB. Commence anticholinergic medication


(eg Oxybutynin) if the IDC is left in situ.

YES

Alternatively, apply one 5mg/24hours


glyceryl trinitrate transdermal
patch to chest or upper arm (NB.
Remove patch once stimulus and
hypertension has resolved or if
BP drops too low).
Administer 25mg captopril
sublingually or other short acting,
rapid onset anti-hypertensive agent

Is BP settling down?
NO

CHECK FOR CONSTIPATION


Insert generous amount of lignocaine 2% (topical anaesthetic)
gel into rectum; wait 3-5 mins, then perform gentle PR exam

Is rectum empty?

NO

If rectum is full and systolic


BP < 150mmHg, perform
manual evacuation

YES

DISCLAIMER
All recommendations are intended for people
with spinal cord injury as a group. Individual
therapeutic decisions must be made by
combining the recommendations with clinical
judgement, informed by a detailed knowledge
of the individual persons unique risks and
medical history, findings on physical
examination, as well as the resources available.

LOOK FOR OTHER CAUSES OF NOCICEPTION


Exclude intra-abdominal pathology, epididymo-orchitis,
pressure sores, burns, ingrown toenail, fracture.
Ensure adequate analgesia (eg. morphine) is given when
there is a persisting known cause of noxious stimulation

If BP not settling promptly or cause not identified,


admit to hospital for BP control & investigation.
Intravenous medication may be necessary
CONTACT SPINAL PHYSICIAN/REGISTRAR ON CALL AT YOUR
NEAREST SPINAL INJURIES UNIT FOR SPECIALIST ADVICE

_ 150 mm Hg
If Systolic BP >
1. Administer glyceryl trinitrate
or captopril as above.
2. If AD worsens with disimpaction,
STOP immediately, instill additional
topical anaesthetic and recheck the
rectum for the presence of stool after
approximately 20 minutes.

This revised algorithm was re-endorsed for use


by the Australian and New Zealand Spinal Cord
Society (ANZSCOS) in September 2010.
This project was funded by the Motor Accidents
Authority of NSW.

4 of 4

Date: 10th of April 2006


amended by Quality & Safety Unit, NSW Health Department
Date: October 2010

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