Reference — Neurology
Autonomic Dysreflexia Emergency Reference
A bedside emergency in spinal cord injury at or above T6: a noxious stimulus below the injury sets off a sympathetic surge that drives the blood pressure to stroke levels. The response is fast and ordered — sit them up, loosen, and hunt the trigger, starting with the bladder.
Educational use only. Autonomic dysreflexia is a true emergency — uncontrolled hypertension can cause seizure, stroke, or death. Initiate the steps below immediately and escalate; antihypertensive choice follows provider orders. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Who’s at Risk & Warning Signs
At risk: spinal cord injury at or above T6, after spinal shock has resolved.
Warning signs: sudden severe hypertension and a pounding headache; flushing, sweating, and skin blotching above the injury; bradycardia; nasal congestion, anxiety, blurred vision; pallor and goosebumps (piloerection) below the injury.
Remember the baseline: a patient with a high SCI often runs a low normal BP, so a reading that looks “normal” may be a dangerous rise for them.
Emergency Response — In Order
- 1SIT THE PATIENT UP — high Fowler's position, lower the legs; orthostasis helps drop the blood pressure immediately
- 2Loosen any tight or constrictive clothing, abdominal binders, or devices
- 3Check the BLADDER first — assess the catheter for kinks/blockage, ensure drainage, and drain a distended bladder (catheterize if needed, using anesthetic lubricant)
- 4Check the BOWEL — if no bladder cause, check for impaction using anesthetic jelly to avoid worsening the stimulus
- 5Inspect the SKIN for any other noxious stimulus (pressure injury, tight strap, ingrown nail, tight shoes)
- 6Monitor blood pressure every 2–5 minutes; give the ordered rapid-acting antihypertensive if BP stays dangerously high, and call for help
Trigger Checklist
| Source | Examples |
|---|---|
| Bladder (most common) | Distension, kinked/blocked catheter, UTI, full leg bag, bladder stones |
| Bowel (second most common) | Impaction, constipation, distension, digital stimulation without prep |
| Skin | Pressure injury, tight clothing/straps, ingrown toenail, burns, ingrown anything below the injury |
| Other | Sexual activity, menstruation/labor, procedures, tight shoes, temperature extremes |
Prevention
The long game is preventing triggers: a faithful bladder program (scheduled catheterization, patent drainage, UTI prevention), a regular bowel program (prevent impaction), meticulous skin care and turning, avoiding tight clothing/devices, and teaching the patient and family to recognize and treat dysreflexia — and to carry a medical-alert card.
NCLEX Pearls
- ✦At risk: SCI at or above T6 after spinal shock resolves.
- ✦Signs: sudden severe hypertension + pounding headache + flushing/sweating ABOVE the injury + bradycardia.
- ✦Response in order: SIT UP → loosen clothing → find/remove the trigger (bladder FIRST, then bowel) → antihypertensive if BP stays high.
- ✦The #1 trigger is the bladder (full/blocked catheter); #2 is bowel impaction.
- ✦Prevention is bladder and bowel programs and skin care — keep catheters patent and bowels regular.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Heart Association / American Stroke Association (AHA/ASA) · American Association of Neuroscience Nurses (AANN). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →