This is an artcile I wrote years ago, and is an updated artcile from an original one I wrote for EMSvillage.com (now defunct) in 2001.
Autonomic Dysreflexia 2007 by Robert S. Cole is licensed under a Creative Commons Attribution 4.0 International License.
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Autonomic Dysreflexia Overview for EMS
1. Autonomic Dysreflexia : An Overview for EMS personnel
By Robert S. Cole, CCEMT-P
“It takes a lot of time to make things go right, but they can all go to hell in a heartbeat.”
-Walter Slovotsky
About the Author: Steve Cole has been involved in EMS and EMS education since 1990. He has worked
for a variety of EMS agencies including volunteer fire, military, hospital based, private, and third service.
He is currently employed by Ada County Paramedics (Boise, Idaho),a top-tier and often besieged Third
Service EMS.
He has no current conflicts of interest with any portion of this article, and has not received from any
commercial interest for its production. He would like to mention that he is open for some money, should a
sufficiently insane commercial enterprise wish to invest in his expansive, eclectic, and somewhat
haphazard quest for EMS excellence.
Comments are welcome. He can be reached by email at: colemedic@hotmail.com
Introduction:
Autonomic Dysreflexia (AD), sometimes known as Hyperreflexia, is a
potentially life threatening condition1
almost completely unique to patients with spinal
cord injuries (SCI). It is characterized by a severe sympathetic response, notably stroke-
level hypertension, and related symptoms. It can be triggered by the most benign and
subtle of events, and can be overlooked easily in its early stages. Fortunately, in many
cases treatment is fairly simple if AD is recognized.
The majority of this article assumes that EMS is called after the fact, and the symptoms
are severe. However, this information is also of use to those providers who transfer SCI
patients to prevent the development of AD caused by inadvertent stimulus.
Incidence and epidemiology:
AD typically occurs in approximately 85% of patient’s with spinal cord injuries above T-
5 (although some cases of T-10 injured patient’s with AD have been reported).2
While
more men than women sustain SCI, this is mainly due to lifestyle and risk-taking
behaviors. Once a cord injury occurs, there is no difference between the occurrence of
AD based on gender, age, or race.
Spinal Cord Injury itself was first discussed in a surgical papyrus dated over 5000 years
ago.3
It described two cases of high cord injury (AKA: Quadriplegia or Tetraplegia) as an
“ailment not to be treated”. Until the advent of modern medicine, however, these patients
seldom survived more than a few weeks. This has changed, with a typical patient
surviving his injury for many, many years. With this ever-increasing life span, more and
more conditions and complications of SCI are being discovered and managed. AD is one
of these conditions.
1
16. 1
Travers, Patricia L.. "Autonomic Dysreflexia: A Clinical Rehabilitation Problem."
www.rehabnurse.org (1999) 29 MAR 2007 <http://rehabnurse.org/ce/010299/auto.htm>.
2
"Other Complications Of Spinal Cord Injury: Autonomic Dysreflexia (Hyperreflexia)." RehabSite.
1998. Louis Calder Memorial Library of the University of Miami/Jackson Memorial Medical
Center. 29 Mar 2007 <http://calder.med.miami.edu/pointis/automatic.html>.
3
Consortium for Spinal Cord Medicine, "Acute Management of Autonomic Dysreflexia: Adults
with Spinal Cord Injury Presenting to Health-Care Facilities." Clinical Practice Guidelines 2nd
editionJul 2001 29 MAR 2007 <http://www.pva.org/site/DocServer/AD2.pdf?docID=565>.
4
Campagnolo, Denise I. "Autonomic Dysreflexia in Spinal Cord Injury." www.emedicine.com. 05
OCT 2006. 29 Mar 2007 <http://www.emedicine.com/pmr/topic217.htm>.
5
Bakewell, S.. "The Autonomic Nervous System ." Update in Anesthesia Issue 5, Article 6(1995)
1-2. 29 MAR 2007 <http://www.nda.ox.ac.uk/wfsa/html/u05/u05_010.htm>.