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After a spinal cord injury, if there is a sudden severe headache and sweating, help the person sit up straight, loosen clothing, and call 120 (China's ambulance number) at the same time

  • Top value
  • Evidence B
  • Buys life
  • Free
  • Takes minutes
  • No willpower

In plain words

In a person with a spinal cord injury, part of the body's alarm wiring is cut. A full bladder or tight clothing may not be felt at all, yet blood pressure can shoot up. The warning signs are a sudden severe headache and sweating. When that happens, first help the person sit up straight, loosen any tight clothing, and check whether the bladder is full, and call 120 (China's ambulance number) at the same time.

Cost

Free. Three actions, done in a few dozen seconds.

What you get

This kind of attack is called autonomic dysreflexia. A systematic review searched four databases (Medline, CINAHL, EMBASE and PsycINFO) and included 31 studies, 6 of which were randomized controlled trials. The review states that the non-drug response during an attack is three steps: put the patient in an upright position, loosen tight clothing, and remove the triggering stimulus. These three steps rest on clinical consensus and physiological data, which is level 5 evidence. Blood-pressure drugs are used only when the pressure stays high; among them prazosin has level 1 evidence and nifedipine and prostaglandin E2 have level 2 evidence. The review also states that strategies to prevent attacks target mainly two common triggers, the urogenital system and surgery, and that most are supported only by level 4 and level 5 evidence.

Notes

Graded B because the three actions on the spot have no randomized controlled trial behind them, only consensus and physiological reasoning. The review itself says most of these measures are supported only by uncontrolled studies. The drug section is for doctors; at home, don't give blood-pressure medicine yourself. Lying the person flat makes blood pressure higher, which is why you help them sit up straight. Family members and caregivers should also know the 3 steps. Don't push through it as an ordinary headache.

Evidence grade
B : Supported by research but without a precise number, or based on small or single studies.
Sources
  1. Krassioukov A, Warburton DE, Teasell R, Eng JJ; Spinal Cord Injury Rehabilitation Evidence Research Team (2009). A systematic review of the management of autonomic dysreflexia after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 90(4):682-695. https://doi.org/10.1016/j.apmr.2008.10.017

Translated from the Chinese original. Original book, section 33, tip 1. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer