A 30-year-old man with a chronic complete spinal cord injury at T4 develops pounding headache, profuse sweating of the face, flushing above the nipple line, and blood pressure of 220/110 mmHg with a pulse of 48 per minute. What is the most appropriate immediate next step?

• A Administer intravenous labetalol before any other action
• B Sit the patient upright and check for bladder catheter blockage or distension ✓
• C Perform urgent CT head to exclude intracranial haemorrhage
• D Give a fluid bolus and evaluate for haemorrhagic shock

Explanation

This is autonomic dysreflexia, seen in injuries above T6, where a noxious stimulus below the lesion, usually a distended or obstructed bladder, triggers unopposed sympathetic vasoconstriction. Hypertension is accompanied by reflex vagal bradycardia and sweating and flushing above the lesion. First-line management is to sit the patient upright, loosen clothing, and remove the trigger such as unkinking or changing the urinary catheter. Drugs are reserved for cases persisting after trigger removal.

Reference: Campbell's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.