A patient with spinal cord injury above T6 suddenly develops severe hypertension, headache, sweating, and bradycardia. This condition is:

1. A

   Neurogenic shock

2. B

   Autonomic dysreflexia

3. C

   Spinal shock

4. D

   Hypovolemic shock

Appeared in: AIIMS Delhi NO- 2019

Explanation

• Autonomic dysreflexia is a medical emergency characterized by an exaggerated sympathetic response to a stimulus below the level of a spinal cord injury (SCI).
• It typically occurs in patients with injuries at or above the T6 level.
• The classic signs include a sudden onset of severe hypertension, a pounding headache, profuse sweating above the level of the lesion, and a compensatory bradycardia (slow heart rate).
• This unique combination of severe hypertension and bradycardia is the hallmark of the condition, differentiating it from other forms of shock.

Why Other Options Were Wrong

• Option A: Neurogenic shock is incorrect because it is characterized by hypotension (low blood pressure) and bradycardia due to a loss of sympathetic tone, which causes vasodilation. The patient in the scenario has severe hypertension.
• Option C: Spinal shock is a temporary condition that occurs immediately after an SCI, involving a total loss of all reflex activity, sensation, and muscle tone (flaccid paralysis) below the level of the injury. It is a state of areflexia, not a hypertensive crisis.
• Option D: Hypovolemic shock is caused by significant fluid or blood loss. It presents with hypotension (low blood pressure) and tachycardia (fast heart rate) as the body tries to compensate for the loss of volume. The patient's symptoms of hypertension and bradycardia are the opposite.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Recognition and management of Autonomic Dysreflexia to guide bedside assessment, documentation, and the next nursing action.
• Recognizing autonomic dysreflexia is a critical nursing skill, as it is a life-threatening emergency that can lead to stroke, seizure, myocardial infarction, or death if not treated promptly.
• The first and most important nursing action is to immediately sit the patient upright to 90 degrees. This uses orthostatic pressure to help lower the blood pressure.
• The next priority is to rapidly identify and remove the triggering stimulus. The most common cause is bladder distention, so checking the urinary catheter for kinks or patency is a primary step.

How to Approach the Question

• First, identify the key patient information: a spinal cord injury (SCI).
• Note the specific level of injury: above T6. This is a critical detail, as it's the threshold for developing autonomic dysreflexia.
• Analyze the cluster of signs and symptoms presented: severe hypertension, headache, sweating, and bradycardia.
• Recognize the paradoxical combination of severe hypertension (a sympathetic response) and bradycardia (a parasympathetic response). This unique pairing is the hallmark of autonomic dysreflexia.
• Systematically rule out the other options. Shock states like neurogenic and hypovolemic shock are primarily characterized by hypotension, which is the opposite of the patient's main symptom.

Concept Tested & Keywords

• Concept Tested: Recognition and management of Autonomic Dysreflexia
• Stem keywords: spinal cord injury, T6, severe hypertension, headache, sweating, bradycardia
• Lead-in keywords: This condition is
• Clinical cues: The combination of a high-level spinal cord injury (above T6) with the paradoxical symptoms of severe hypertension and bradycardia is the classic presentation of Autonomic Dysreflexia.
• Negative lead-in flag: false

Question ID

qr1c27hWKdp67BrVJ_c6r

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Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 pp. 102-104, 99-101

E6 Physiology Guyton 4SAE Part 2A p. 30-32