Cardio-vascular system

Autonomic dysreflexia: Tetraplegic patients and some high thoracic paraplegic patients can suffer autonomic dysreflexia. This is caused by an abnormal response to ‘would be’ painful stimuli by the isolated/decompensate autonomic systems.

The condition presents with severe hypotension, bradycardia, pounding headache, flushed blotchy skin and occasionally with profuse sweating above the level of the injury.

In the majority of the instances autonomic dysreflexia is precipitated by a distended bladder or mal-positioned catheter in the urethra. Other causes of dysreflexia include distended bowel (usually with severe constipation or impaction), ingrowing toenails, pressure sores, burns, sunburn, urinary tract infection, bladder spasm, renal calculi, bladder calculi, visceral pain due to appendicitis, cholecystitis etc, pregnancy, parturition, deep venous thrombosis, limb fractures etc.

Most tetraplegic patients or their carers can often identify the precipitating cause of dysreflexia.

This is a medical emergency and needs prompt resolution of the precipitating cause. If the bladder is distended immediate catheterisation would be indicated. If the catheter has been inflated in the prostatic /bladder neck area, deflation of the balloon and reintroduction would reduce symptoms.

Medical management includes:

Sit the patient up
Sublingual Glycerol Tri-nitrate or Coro-nitro spray (200-400 micrograms) or Nifedipine

Dysreflexia related to anal fissure causing severe anal sphincter spasm and constipation could be reduced with the use of local Lignocaine /Xylocaine gel applied before bowel evacuation.