رجل عمره ٣٤ سنة عنده إصابة نخاع شوكي على مستوى T4 منذ سنتين، في الجناح لعلاج قرحة ضغط. اشتكى فجأة من صداع شديد وزغللة، والضغط ٢١٠/١١٠، والنبض ٥٢، ووجهه محمر ويتعرق فوق مستوى الإصابة. لم تُفرغ قسطرته منذ ساعات. ما أول إجراء؟

A 34-year-old man with a T4 spinal cord injury for two years is on the ward for a pressure ulcer. Suddenly he has a severe headache and blurred vision; BP 210/110, HR 52, flushed and sweating above the injury level. His catheter has not drained for hours. What is the first action?

1. Check the bladder and catheter for an obstruction
2. Give an IV antihypertensive per protocol
3. Keep him supine and elevate his legs
4. Sit him upright and lower his legs

Answer: D) Sit him upright and lower his legs. This is autonomic dysreflexia; the first step is sitting him up with legs down to lower BP by gravity, then immediately looking for the trigger, most often a full bladder or blocked catheter. Drugs are used if BP stays high, and raising the legs worsens the hypertension.