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학습 자료 둘러보기 →The priority finding is a blood pressure of 180/110 mmHg with bradycardia and diaphoresis above the injury level. This is a classic presentation of autonomic dysreflexia, a life-threatening hypertensive emergency triggered by a noxious stimulus below the level of a T6 or higher spinal cord injury.
Immediately elevate the head of the bed to 90 degrees and lower the legs to orthostatically reduce blood pressure. Then, rapidly identify and remove the triggering stimulus. The most common cause is a distended bladder; check for kinked catheter tubing or perform straight catheterization. If not the bladder, assess for fecal impaction, but apply anesthetic lubricant first to avoid exacerbating the episode.
Never ignore severe hypertension in a patient with high-level SCI. If symptoms persist after removing the stimulus, administer rapid-onset, short-duration antihypertensives as prescribed while continuing to monitor for a hypertensive crisis that can lead to stroke or seizure.
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