What is the appropriate initial management for autonomic dysreflexia?

• A. Administer antihypertensive drug immediately.
• B. Identify and treat the triggering stimulus (e.g., bladder/rectum distention).
• C. Perform spinal cord decompression.
• D. Increase sensory stimulation.

Answer: (B)

Autonomic dysreflexia is an emergency that occurs when a noxious stimulus below a high spinal cord injury triggers an unchecked sympathetic response, causing a dangerous rise in blood pressure. The first priority is to identify and remove the triggering stimulus, most often bladder distension or rectal impaction. This means checking and ensuring the urinary catheter is patent and the bladder is emptied, assessing for stool impaction, and removing any tight clothing or irritants. Position the patient upright to help lower blood pressure and monitor the response. If high blood pressure persists after eliminating triggers, then administer a fast-acting antihypertensive, but removing triggers comes first.