امرأة عمرها ٣٠ سنة عندها إصابة حبل شوكي عند T4 قبل سنة. وهي في كرسيها المتحرك، صار عندها فجأة صداع شديد، وضغطها ٢١٠/١١٠، ونبضها ٥٠، وتعرق ووجهها أحمر. تقول إنها لم تفرغ المثانة منذ ٦ ساعات. ما أول إجراء؟

A 30-year-old woman with a T4 spinal cord injury for a year suddenly develops a severe headache in her wheelchair; BP 210/110, HR 50, sweating and flushed face. She says she has not emptied her bladder for 6 hours. What is the first action?

1. Sit him up and look for the trigger, e.g. bladder
2. Lay him flat with the legs raised
3. Warm him with blankets because he seems to be shivering
4. Give analgesia and recheck BP in an hour

Answer: A) Sit him up and look for the trigger, e.g. bladder. Autonomic dysreflexia occurs with injuries at T6 or above from a stimulus below the lesion, most often bladder distension or constipation. Sit him up, loosen tight clothing, check the catheter, bladder and bowel, then give antihypertensives if it persists.