Management of autonomic dysreflexia in the community

The World Health Organization (2013) estimated that some 250 000–500 000 people sustain a spinal cord injury every year, and Aspire (2019) estimated that 2500 of these cases occur in the UK. As many as 90% of patients with injuries above the 6th thoracic vertebrae, are susceptible to autonomic dysreflexia (AD) (Allen and Leslie, 2019). These patients live in the community with varying levels of independence and support. Most will have contact with community nurses due to potential issues with bladder and bowel management and, therefore, community nurses may come into contact with patients in a dysreflexia crisis, which is an acute medical emergency requiring prompt treatment or emergency transfer to secondary care. The aim of this paper is to develop and enhance community nurses' understanding of the care and management of autonomic dysreflexia.

Jordan et al (2016) defined AD as an episodic uncontrolled elevation of systolic blood pressure of more than 20 mmHg, accompanied sometimes by a resulting bradycardia. If hypertension is not managed in individuals affected by AD, it can lead to cerebral and spinal haemorrhage, seizures and pulmonary oedema (Alexander et al, 2011). AD often presents itself in the chronic phase of spinal cord injury, most often 3–6 months after the initial injury (Lindan et al, 1980). AD is a medical emergency that community nurses need to identify and react to quickly to prevent further complications.