Acute Management of Autonomic Dysreflexia. - 17

CLINICAL PRACTICE GUIDELINES
the episode. Further causes related to the urinary,
gastrointestinal, integumentary, reproductive, and
other body systems are detailed in Potential Causes
on page 10.
24. Following an episode of autonomic dysreflexia,
instruct the individual to monitor symptoms
and blood pressure for at least 2 hours
after resolution of the episode to make sure
that it does not reoccur.
Educate the individual to seek
immediate medical attention if it
reoccurs.
Monitor inpatients closely for at least 2
hours, as deemed necessary by the
health-care provider.
Seek the pregnant woman’s obstetricalcare
provider for evaluation.
(Scientific evidence–None; Grade of recommendation–
Expert consensus; Strength of panel opinion–Strong)
The hypertension and symptoms may have
resolved because of the medication rather than the
treatment of the cause. Symptoms managed by
pharmacologic treatment may begin to reverse
themselves within this time frame.
25. Consider admitting the individual to the hospital
for monitoring to maintain pharmacologic
control of the blood pressure, and to
investigate other causes:
If there is poor response to the
treatment specified above.
If the cause has not been identified.
If there is suspicion of an obstetrical
complication.
(Scientific evidence–V; Grade of recommendation–C;
Strength of panel opinion–Strong)
Because of the loss of sensation, individuals
with spinal cord injury can have significant pathology
with minimal symptoms. These may include
problems such as acute abdominal pathology, long
bone fractures, and ingrown toenails (Braddom
and Rocco, 1991). Individuals with spinal cord
injury frequently may have a positive urine culture.
However, this may not be the precipitating cause
for autonomic dysreflexia, and therefore other
causes of autonomic dysreflexia also should be
investigated.
26. Document the episode in the individual’s
medical record, including
17
Presenting signs and symptoms and their
course.
Treatment instituted.
Recordings of blood pressure and pulse.
Response to treatment.
Evaluate the effectiveness of the treatment
according to the level of outcome criteria
reached:
Cause of the episode has been identified.
Blood pressure has been restored to
normal limits for the individual (usually
90 to 110 systolic mm Hg for a
tetraplegic individual in the sitting
position).
Pulse rate has been restored to normal
limits.
The individual is comfortable, with no
signs or symptoms of autonomic
dysreflexia, of increased intracranial
pressure, or of heart failure.
An education plan has been completed
and included preventive and emergency
management guidance.
(Scientific evidence–None; Grade of recommendation–Expert
consensus; Strength of panel opinion–Strong)
27. Once the individual with spinal cord injury
has been stabilized, review the precipitating
cause of the AD episode with the individual,
family members, significant others, and caregivers.
This preventive process entails:
Adjusting the treatment plan to ensure
that future episodes are recognized and
treated to prevent a medical crisis or,
ideally, are avoided altogether.
Discussing autonomic dysreflexia during
the individual’s education program, so
that he or she will be able to minimize
the risks known to precipitate AD, solve
problems, recognize early onset, and
obtain help as quickly as possible.
Providing the individual with education
about the prevention and treatment of
autonomic dysreflexia at the time of
discharge that can be referred to in an
emergency.
(Scientific evidence–None; Grade of recommendation–
Expert consensus; Strength of panel opinion–Strong)
Acute Management of Autonomic Dysreflexia.

Table of Contents for the Digital Edition of Acute Management of Autonomic Dysreflexia.
