Quick answer
If you have a spinal cord injury at or above T6, autonomic dysreflexia (AD) can send your blood pressure dangerously high in minutes — often from something as simple as a blocked catheter. The people who find you may not know what AD is, and may not know that your normal blood pressure is low. Victoria’s spinal service says everyone with an injury at or above T6 should carry an emergency card; a medical ID puts that card on your wrist.
Most emergencies are obvious to a bystander. Autonomic dysreflexia is not. A person with a high-level spinal cord injury may be sitting upright in their chair, sweating, flushed and complaining of a pounding headache, and the cause may be below their injury where they cannot feel it. Unless someone knows what to look for, the minutes that matter are spent on the wrong questions. This guide explains what AD is, what triggers it, what should happen first, and how a spinal cord injury medical ID helps the people around you act quickly.
What autonomic dysreflexia is
According to the Queensland Spinal Cord Injuries Service, autonomic dysreflexia is a medical emergency that occurs in people with a spinal cord injury at or above the T6 level. It is a sudden rise in systolic blood pressure — typically more than 20 mmHg above the person’s usual resting blood pressure — in response to a trigger below the level of injury. Because messages between body and brain cannot cross the injury, the body’s response runs unchecked until the trigger is removed.
Untreated, the service warns, AD can cause stroke, seizures, heart attack and death. Austin Health’s Victorian Spinal Cord Service adds that it is most likely in people with a complete injury but can also happen with an incomplete one.
The number a stranger will get wrong
QSCIS notes that the usual blood pressure of someone with a high-level spinal cord injury is often lower than the general population’s — around 90/60, for example. A reading a paramedic would call “normal” may be dangerously high for you. Your baseline blood pressure is the single most useful number on your record.
Signs of autonomic dysreflexia
QSCIS lists symptoms that range in severity and may include:
- a pounding headache
- sweating and a blotchy rash or flushing above the level of injury
- chest tightness
- blurred vision and a blocked nose
- goosebumps and anxiety
Some people have no symptoms at all — what QSCIS calls silent AD — and it should be treated with the same urgency. The service is clear: autonomic dysreflexia is a medical emergency, and you should call Triple Zero (000) if required.
What triggers it
The trigger is usually something irritating or painful below the injury, even if the person cannot feel it. The most common causes QSCIS lists are:
| Area | Examples |
|---|---|
| Bladder | An overfull bladder, often from a blocked or kinked catheter or a missed intermittent catheterisation; bladder or kidney stones |
| Bowel | Constipation, haemorrhoids, anal fissures and other rectal conditions |
| Skin and clothing | Tight or restrictive clothing or equipment such as abdominal binders, compression stockings or tight shoes |
| Injuries | Fractures, which are more likely because of low bone density |
| Procedures and illness | Colonoscopy or cystoscopy; abdominal emergencies; testicular conditions |
What should happen first
The QSCIS management steps start with actions anyone can help with:
Suspected autonomic dysreflexia
- Sit the person upright if possible, to help lower blood pressure.
- Call for help — Triple Zero (000) if you are not in a health facility.
- Loosen or remove anything tight: binders, stockings, shoes.
- Look for the cause, starting with the bladder — is the catheter tubing kinked, or the bag full? Ask the person: they often know.
- If a blood pressure machine is available, check every 2–5 minutes.
Austin Health stresses that people with spinal cord injury should be able to help direct their own care during an episode — which works only if they are conscious and able to speak. When they are not, the record has to speak for them. Medicines and clinical treatment of AD are for paramedics and doctors following their guidelines; we deliberately do not give doses here.
Why the spinal service recommends a card
Austin Health is direct: “An emergency wallet card should be carried by all clients with SCI at or above T6. This will help emergency responders to quickly understand their needs.” For people in rural or remote areas it also describes keeping an emergency box at home, with an information card, a blood pressure machine and supplies agreed with the spinal physician.
Australian resuscitation guidance tells responders to look. ANZCOR Guideline 2 includes, in the initial assessment of an emergency, checking for “physical (eg. alert jewellery) or electronic alert devices (eg. smartphone application) that may be relevant to assessment or management”. A wallet card has to be found and read; a band on the wrist is seen in the first minute, and the number on it can open the full detail.
What a spinal cord injury medical ID should say
On the band
- SPINAL CORD INJURY — LEVEL (for example C6 complete)
- AUTONOMIC DYSREFLEXIA RISK — USUAL BP [your figure]
- Your membership number, so the rest can be read
In the profile
- Your injury level and whether it is complete or incomplete.
- Your usual resting blood pressure, and how your AD usually shows itself.
- Your known triggers, and your bladder and bowel routine: catheter type and size, intermittent catheterisation times, bowel care days.
- Your AD management plan from your spinal service, including any medicine your spinal physician has prescribed for episodes.
- Your spinal unit and its after-hours number, your GP, and your support workers.
- Other conditions, medicines and allergies, and any implant or pump. See what counts as a medical implant or device.
- Emergency contacts who know your routine.
Your injury level, your usual blood pressure, your AD plan — readable before the wrong number is trusted.
A MedibandPlus profile stores your spinal cord injury details, autonomic dysreflexia plan, bladder and bowel routine and contacts behind a membership number on a band you wear. No app, no login, from $19 a year.
Set up your profilePart of the Mediband family. Designed in Australia since 2004.
After an episode, and in pregnancy
Austin Health notes that after an episode people are more at risk of another in the following days, and that activities normally well tolerated — stretches, bowel or bladder care — may trigger a further one. It also notes that women with an injury at or above T6 are at risk of AD during pregnancy, labour and after the birth, and that the obstetrician, anaesthetist, GP and spinal physician all need to know. Both are good reasons to keep the profile up to date and to share it with every new team.
For support workers and family
If you support someone with a high-level spinal cord injury, learn their signs and their plan, and make sure you know where their card, band and blood pressure machine are. If you are their main carer, plan for your own emergency too; our carer emergency plan guide explains how. For calling for help, see five things to know when calling an ambulance, and for listing contacts, how to set up your emergency contacts.
Keeping it current
Update the record when your catheter or bowel routine changes, when your usual blood pressure changes, after any episode that needed medical care, and after every spinal service review. Spinal Cord Injuries Australia keeps a collection of AD resources for people living with spinal cord injury.
FAQs
What is autonomic dysreflexia?
A medical emergency in people with a spinal cord injury at or above T6, described by the Queensland Spinal Cord Injuries Service as a sudden rise in systolic blood pressure, typically more than 20 mmHg above the person’s usual level, triggered by something below the injury. Untreated, it can cause stroke, seizures, heart attack and death.
What are the signs of autonomic dysreflexia?
A pounding headache, sweating, a blotchy rash or flushing, chest tightness, blurred vision, a blocked nose, goosebumps and anxiety. Some people have no symptoms, which QSCIS calls silent autonomic dysreflexia and which needs the same urgency.
What usually triggers autonomic dysreflexia?
Something irritating or painful below the injury, even if it cannot be felt. The most common cause is an overfull bladder from a blocked or kinked catheter or a missed catheterisation. Bowel problems, tight clothing or equipment, fractures, procedures and abdominal emergencies can also trigger it.
What should a bystander do?
Sit the person upright if possible, call for help or Triple Zero (000), loosen anything tight, and look for the cause starting with the catheter and bladder. Ask the person, who often knows what is wrong. If a blood pressure machine is available, check every two to five minutes.
Why is my usual blood pressure important?
Because it is often lower than the general population’s after a high-level spinal cord injury, around 90/60 for example. A reading that looks normal to a stranger may be dangerously high for you, so your baseline belongs on your band and in your record.
Should people with spinal cord injury carry an emergency card?
Yes. Austin Health’s Victorian Spinal Cord Service states that an emergency wallet card should be carried by everyone with a spinal cord injury at or above T6, to help emergency responders quickly understand their needs. A medical ID band makes that information visible at a glance.
What should a spinal cord injury medical ID say?
On the band: your injury level, “autonomic dysreflexia risk”, your usual blood pressure and a number that opens your record. In the record: complete or incomplete injury, known triggers, bladder and bowel routine, your AD plan, your spinal unit and emergency contacts.
Sources
- Queensland Spinal Cord Injuries Service — Autonomic dysreflexia — definition, usual blood pressure, symptoms, triggers and first steps.
- Austin Health — Autonomic Dysreflexia — emergency wallet card recommendation, recurrence, pregnancy and rural care.
- Spinal Cord Injuries Australia — Autonomic dysreflexia resources — resources for people living with spinal cord injury.
- ANZCOR Guideline 2 — Managing an Emergency — checking for alert jewellery and devices.
Disclaimer: This article is general information about recording spinal cord injury details for emergencies, not medical advice. It does not replace the autonomic dysreflexia management plan from your spinal service or accredited first aid training. Medicines for autonomic dysreflexia must only be used as prescribed. In an emergency, always call Triple Zero (000). For non-urgent health advice, call healthdirect on 1800 022 222 (NURSE-ON-CALL 1300 60 60 24 in Victoria, 13 HEALTH 13 43 25 84 in Queensland).
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