Spinal Cord Injury: A Care Staff Guide, Including Autonomic Dysreflexia

A spinal cord injury can change almost every aspect of a person's life, from movement and sensation to bladder, bowel and blood pressure control. People with these injuries are often cared for in hospitals, care homes and the community by staff who do not work in specialist spinal units. Knowing the key risks, especially autonomic dysreflexia, can prevent harm. This guide sets out the core care points for care and healthcare staff.

It is general information, not clinical advice. Every person has an individual care plan, and specialist spinal teams should be involved wherever possible. Follow your local protocols and the person's own routines.

Why spinal cord injury care is different

The spinal cord carries messages between the brain and the body. When it is injured, signals are interrupted below the level of the injury. People may lose movement, feeling and normal control of their bladder, bowel and blood pressure. They may not feel pain from pressure, infection or injury, so staff often need to look for signs that a person cannot feel.

Autonomic dysreflexia: a medical emergency

Autonomic dysreflexia, often shortened to AD, is a serious reaction that can happen in people with injuries at around the sixth thoracic level or above. According to spinal injury specialists, it is triggered by something painful or irritating below the level of the injury, even though the person may not feel it. The most common triggers are:

• problems with the bladder, such as a blocked catheter or an infection
• problems with the bowel, such as constipation
• pressure ulcers, tight clothing or other irritation

Warning signs listed in specialist guidance include a sudden rise in blood pressure, a pounding headache, blurred vision, sweating and flushing above the level of injury, nasal congestion, and a change in heart rate. One hospital procedure describes a sudden severe rise in blood pressure, pounding headache, sweating, anxiety and chest tightness.

What staff should do

1. Sit the person upright, if safe to do so.
2. Loosen tight clothing, belts or devices.
3. Check the bladder and catheter for blockage or kinking.
4. Check for constipation or bowel problems.
5. Monitor blood pressure, and call for urgent help.

If these measures do not bring the blood pressure down, or you cannot find the cause, the person needs emergency medical care. Follow the person's emergency plan and local protocol. Never ignore a pounding headache or high blood pressure in someone with a spinal cord injury.

Pressure ulcer prevention

Because people with a spinal cord injury may not feel pressure damage, skin care is critical. One NHS hospital procedure says that three to four hourly turns should be done at night, or as guided by the person's usual turning routine. Keep repositioning charts up to date, and check areas under equipment such as wheelchairs, splints and cushions. Our pressure ulcer prevention guide covers risk assessment and prevention in detail.

Bladder care

Many people use catheters, either self-retaining or suprapubic, or have their own established routine. Continue the person's home routine, keep strict input and output records, and arrange regular catheter changes. Report blockages, leaks, cloudy or smelly urine, fever or a sudden change in the person's condition. See our catheter care guide for practical care.

Bowel care

People with a spinal cord injury often follow a planned bowel programme, which may use suppositories or micro-enemas. Keep to the person's pre-admission routine and document stool patterns, and if the usual products are not available, ask the prescriber for an alternative. Constipation is a common trigger for autonomic dysreflexia. Our bowel management guide covers general principles.

Other points to watch

• Breathing. High injuries can affect the muscles used for breathing, so report any change in breathing or a weak cough.
• Temperature. People may not regulate temperature normally, so avoid very hot or cold environments.
• Mobility equipment. Continue to use wheelchairs, splints and other aids unless told otherwise.
• Mood and wellbeing. Adjusting to injury is hard, so listen and report low mood, anxiety or withdrawal.

Know who to call

Find out in advance who to contact for advice, such as the person's regional spinal injury centre, a clinical nurse specialist, an on-call doctor or the GP. Write the numbers into the care plan. If the person has an emergency card or plan, keep it with them and make sure every staff member knows where it is.

Frequently asked questions

What is the biggest danger to look for?

Autonomic dysreflexia, which can cause a dangerous rise in blood pressure. Recognise the signs and act quickly.

Why is skin care so important?

The person may not feel pressure damage, so ulcers can develop quickly without pain as a warning.

Should care staff give emergency medicines?

Only if they are trained, authorised and the person's plan allows it. Otherwise call for medical help.

Where can teams find training?

See the CPD hub for professional development options for care and healthcare teams.

Learnsignal will update this guide as national guidance develops.