Synopsis
Distinguish transient spinal areflexia from neurogenic circulatory shock, recognise autonomic dysreflexia as a hypertensive emergency, remove common triggers safely, and prevent cerebral and cardiac complications.
- Spinal shock is flaccidity and areflexia below an acute cord lesion; neurogenic shock is hypotension from sympathetic loss; autonomic dysreflexia is later episodic hypertension, usually with lesions at T6 or above.
- Know the person's baseline pressure because a clinically dangerous rise can occur before an absolute threshold appears striking by general-population standards.
- For suspected dysreflexia, sit upright and lower legs if safe, remove tight garments and abdominal binders, and measure pressure and pulse every 2–5 minutes.
Key red flags
Sudden pounding headache, marked rise above usual low blood pressure, flushing or sweating above the lesion, nasal congestion, visual change and piloerection after a T6-or-higher cord lesion is autonomic dysreflexia until proven otherwise.
Investigation priorities
Confirm the hypertensive change and detect dangerous bradycardia or arrhythmia.
Management branches
A susceptible person develops abrupt headache, autonomic signs and blood-pressure rise.
- Sit upright, lower legs when safe, loosen restrictive garments and call spinal and emergency support while recording pressure and pulse every few minutes.
- Ask the patient about their usual trigger and rescue plan, current catheter, bowel routine and recent medicines including PDE5 inhibitors.
Key medicines
Glyceryl trinitrate sublingual spray for protocol-defined dysreflexiaIf the individual emergency plan specifies GTN and pressure remains dangerously high, give 1–2 metered sprays of 400 micrograms each under the tongue while seated; repeat only under the monitored local protocol, not exceeding 3 sprays in 15 minutes.