A 21-year-old male with quadriplegia has a BP 236/106, pulse 68, RR 12, and is hot to the touch. What is the likely diagnosis?

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A 21-year-old male with quadriplegia has a BP 236/106, pulse 68, RR 12, and is hot to the touch. What is the likely diagnosis?

Autonomic dysreflexia occurs in people with high-level spinal cord injuries when a noxious stimulus below the level of injury triggers a massive sympathetic response. The brain can’t modulate this outflow, so below the injury there’s extreme vasoconstriction, causing a dangerous rise in blood pressure. The heart rate may drop or stay slow (bradycardia) as a reflex from the baroreceptors trying to compensate, which fits this patient’s pulse of 68 despite a very high blood pressure. In quadriplegia, this reaction is a classic emergency because a stimulus like bladder distension, bowel impaction, a tight clothing band, or a pressure sore below the injury can ignite it. The hot skin described here can reflect sweating above the injury, another sign of autonomic involvement. Immediate focus is on eliminating the trigger and preventing further BP rise: position the patient upright to help lower blood pressure, remove any tight clothing or devices, and identify and relieve the stimulus (commonly a full bladder or impacted bowel). Ongoing hypertension may require pharmacologic treatment as per protocol and urgent transport for definitive care, since autonomic dysreflexia can quickly become life-threatening if not controlled.

Autonomic dysreflexia occurs in people with high-level spinal cord injuries when a noxious stimulus below the level of injury triggers a massive sympathetic response. The brain can’t modulate this outflow, so below the injury there’s extreme vasoconstriction, causing a dangerous rise in blood pressure. The heart rate may drop or stay slow (bradycardia) as a reflex from the baroreceptors trying to compensate, which fits this patient’s pulse of 68 despite a very high blood pressure. In quadriplegia, this reaction is a classic emergency because a stimulus like bladder distension, bowel impaction, a tight clothing band, or a pressure sore below the injury can ignite it. The hot skin described here can reflect sweating above the injury, another sign of autonomic involvement.

Immediate focus is on eliminating the trigger and preventing further BP rise: position the patient upright to help lower blood pressure, remove any tight clothing or devices, and identify and relieve the stimulus (commonly a full bladder or impacted bowel). Ongoing hypertension may require pharmacologic treatment as per protocol and urgent transport for definitive care, since autonomic dysreflexia can quickly become life-threatening if not controlled.

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