Reflexive Rex — Spinal Cord Injury & Autonomic Dysreflexia
Pounding headache, BP 220/120, bradycardia — sit him up and find the trigger
Rex hasn't been catheterized on schedule, and now he has a pounding headache and flushed, blotchy skin above his injury. His blood pressure reads 224/126 and his pulse is 48.
Rex has a T4 spinal cord injury. Below the level of injury, his body can no longer regulate the sympathetic nervous system, so a full bladder, impacted bowel or tight clothing can trigger a massive, unopposed sympathetic surge. Blood pressure skyrockets, the heart reflexively slows, and a stroke or seizure can follow within minutes if the trigger is not found and removed fast.
Read Reflexive Rex's full story →The story arc
The setup
Rex's spinal cord injury at T4 leaves everything below that level without brainstem control over blood vessel tone.
The turn
His indwelling catheter has been kinked for hours, and his bladder is distended and tender though he cannot feel it.
The crisis
A pounding headache, profuse sweating and flushing above the injury, blotchy skin below it, blood pressure 224/126, and a pulse of 48.
The save
The nurse immediately sits Rex upright, loosens tight clothing, checks for a kinked catheter or bladder distention first, and disimpacts only after blood pressure is controlled.
NCLEX study section — Spinal Cord Injury & Autonomic Dysreflexia
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Neurological
Take this chapter into practice questions on the same topic.