A 34-year-old man with chronic complete paraplegia at T4 develops sudden pounding headache, profuse facial sweating and flushing above the nipple line, with blood pressure 210/115 mmHg and heart rate 50 per minute. His indwelling catheter is found kinked. After sitting him upright, what is the next priority?
- A Give intravenous labetalol immediately
- B Relieve the catheter obstruction and drain the bladder ✓
- C Perform immediate lumbar puncture
- D Administer sublingual nifedipine and observe supine
Correct answer: B. Relieve the catheter obstruction and drain the bladder
Explanation
This is autonomic dysreflexia, seen in lesions above T6, where noxious stimuli below the lesion trigger unopposed sympathetic vasoconstriction with compensatory vagal bradycardia. Bladder distension is the commonest trigger. Removing the cause by relieving the catheter obstruction is definitive and must precede antihypertensives, which are reserved for persisting hypertension after the stimulus is eliminated. Keeping the patient upright lowers blood pressure through venous pooling.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.