1. ATTENTION! The “normal” baseline BP of persons with high SCI is usually 90/60mmHg in supine position and even lower in sitting position. An increase >20mmHg above baseline BP is an AD episode, and if this not treated immediately, may lead to extremely increased BP (240/130mmHg) History of AD episodes : Frequency:______________ Usual cause:____________________ BP up to __________mmHg Symptoms:_____________________ _ Usual treatment:_________________ _______________________________ History of AD episodes : Frequency:______________ Usual cause:____________________ BP up to __________mmHg Symptoms:_____________________ _ Usual treatment:_________________ _______________________________ History of AD episodes : Frequency:______________ Usual cause:____________________ BP up to __________mmHg Symptoms:_____________________ _ Usual treatment:_________________ _______________________________ Notes: _____________________ ________________________________ ________________________________ ________________________________ More information: PRM department : ___________________ _________________________________ _ Related sites: http://emedicine.medscape.com/article /322809-overview http://emedicine.medscape.com/article /322809-overview http://sci.washington.edu/info/forums/report s/autonomic_dysreflexia.asp#report Medical information has been endorsed by the ………… Society PRM, …….., 2016 By the SIG for SCI of ESPRM,, 2016 In accordance with international guidelines MEDICAL EMERGENCY CARD for AUTONOMIC DYSREFLEXIA (sadden hypertensive crisis) Patient with spinal cord injury above T6 neurotome level Name: __________________________ Neurological level of Injury ( ISCoS / ASIA): ________________________ Basic BP: ______________mmHg Allergies: ______________________ Rehabilitation Department: ________ ________________________________ Tel:____________________________ Tel of relative: ______________ …………….. SOCIETY OF PRM 2016 Logo of National PRM Society

2. AUTONOMIC DYSREFLEXIA (AD ) Patient with tetraplegia or high paraplegia (SCI above T6) may present a sudden dysfunction of autonomic nervous system resulting from stimulus below neurological level of injury, this dysfunction is called: AD AD is an unopposed overactivity of sympathetic nervous system, leading to a sudden increase of blood pressure. If AD is not treated in time may lead to intracranial haemorrhage, stroke, seizures or even death COMMON SYMPTOMS & SIGNS feeling of great anxiety high BP, sudden rapid increase pounding headache flushing & sweating above the level of injury paling, vasoconstriction below the level of injury (sweating sometimes) slow or rapid heart rate breathing difficulty blurring of vision stuffy nose Nausea COMMON CAUSES urine retention plugged catheter fecal impaction pressure sore or burn ingrown toenail fractures of lower limbs UTI any noxious stimulus below the level of injury sit patient upright (not lying down) Monitor blood pressure (BP) every 3-5 min Remove whatever is tight below the level of the lesion (clothing, etc.) quick exam to include abdomen for distended bladder or bowel, lower limbs for skin lesion, fractures, e.t.c. in order to reveal the stimulus that caused AD and treat it If indwelling urinary catheter is in place, check for obstructions If an indwelling catheter is not in place, catheterize the patient using anesthetic jelly ATTENTION: If there is a need to check bowel, this must be done using anesthetic jelly If BP despite previous management is high (>150mmHg), give an antihypertensive with rapid onset and short duration (e.g.sublingual nifedipine), may repeat in 20-30min, and continue investigate causes of AD If IV antihypertensives are needed, this should be done only in a monitoring setting of ICU