SCI-05 · Autonomic Dysreflexia

Autonomic Dysreflexia. Part of the Spinal Cord Injury series of the Reflex PM&R Board Review podcast. Audio correction: In the audio: The drug effect stops almost instantly. You cannot unswallow a pill. That single property of immediate reversibility is why nitroglycerin paste remains the definitive first-line treatment. — Correct: Wiping the ointment off stops further delivery. It does not reverse the drug already absorbed, and the blood pressure does not return to baseline instantly. Wipe the paste once the trigger has been treated and the systolic pressure is within about 20 mmHg of baseline, then keep measuring blood pressure every 2 to 5 minutes through the recovery and observe for at least 2 hours for rebound hypertension or for hypotension. Treat symptomatic hypotension supine with the legs elevated. Removability is a real advantage over an oral agent, but the PVA appendix table is a set of options rather than a mandatory ranked ladder. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/SCI-05.