Autonomic Dysreflexia: What You Should Know

A Guide for People with

AUTONOMIC DYSREFLEXIA: WHAT YOU SHOULD KNOW

Consortium for Spinal Cord Medicine Administrative and financial support provided by Paralyzed Veterans of America What to Do If You Think You Have Autonomic Dysreflexia:

PromptImportant: action is essential! You need to If stayyou can’tsitting follow or upright these until steps your yourself, tell a family member, anblood attendant, pressure or isa backfriend to what normal. to do. It’s important to do these steps in the order below. 1. Sit up, or raise your head to 90 degrees. If you can lower your legs, do. ■ ■

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2. Loosen or take off anything tight: External catheter tape Abdominal binders Clothes Shoes or leg braces Elastic hose or bandages Leg bag straps 3. If you have a blood pressure kit, take your blood pressure read ing about every 5 minutes to see if you’re getting better. 4. Check to see if your bladder is draining properly (see page 4, step 4). 5. Call your health-care professional, even if the warning signs go away. Report the symptoms you had and what you did to correct the problem.■ 6. If the warning signs come back again, repeat these steps. Even ■ if the warning signs go away again, call your health-care ■professional and go to the emergency room. 7. At■ the emergency room, make sure you: Tell the emergency room staff that you think you may have autonomic dysreflexia and need immediate treatment. ■ Ask to have your blood pressure checked immediately. Request to keep sitting up as long as your blood pressure is high. Important: Ask the emergencyInform the emergencyroom staff roomto look staff for thatcauses there of isthe a problem. Suggest thatcomplete they clinicalcheck forpractice causes guideline in this order:available (1) atbladder the , (2) bowel,website: and (3) www.pva.orgother causes.. Suggest that your health-care professional instill anesthetic jelly into your rectum before checking your bowel. AUTONOMIC DYSREFLEXIA: WHAT YOU SHOULD KNOW A Guide for People with Spinal Cord Injury

Contents ii 1 1 1 Acknowledgments...... 1 Who Should Read This Guide?...... 2 Why Is This Guide Important?...... 2 What Is Autonomic Dysreflexia? ...... 2 Sidebar: Quick Overview...... 3 What Causes Autonomic Dysreflexia? ...... 4 What Are the More Common Warning Signs?...... 6 Sidebar: Here’s What Happens in Autonomic Dysreflexia ...... 7 If I Think I Have Autonomic Dysreflexia, What Should I Do?...... 8 Sidebar: Bladder Management Tips ...... 10 Sidebar: Talk About It ...... 11 What Goes in an Autonomic Dysreflexia Kit?...... Table: Common Causes of Autonomic Dysreflexia: ...... TheGlossary information...... in this Guide is not intended to substitute for prompt profes sional care. If you develop warning signs of autonomic dysreflexia, contact a physicianMy Personal or other Autonomic appropriate Dysreflexia health-care Diary professional ...... as soon as possible. This Guide has been prepared based on scientific and professional information known about autonomic dysreflexia, its causes, and treatment, in 1997. It is rec ommended that you periodically review this Guide with health-care professionals from whom you regularly receive care.

Consortium for Spinal Cord Medicine i Administrative and financial support provided by the Paralyzed Veterans of America Copyright 1997, PARALYZED VETERANS OF AMERICA August 1997 Acknowledgments Consumer Panel Members Todd A.Linsenmeyer, MD Chair and Steering Committee Liaison

The Consortium for Spinal Cord Medicine for development of clinical practice guidelines is Andrea K.Biddle, PhD, MPH composed of 17 organizations interested in spinal Methodologist Kessler Institute for Rehabilitation cord injury care and treatment. The Consortium West Orange, New Jersey Departments of Surgery (Urology) & Physical Steering Committee established a guideline Medicine and Rehabilitation development panel to make recommendations on UMDNJ; New Jersey School of Medicine how best to prevent and treat autonomic dysre Newark, New Jersey flexia because of its life-threatening nature. The Diana Cardenas, MD consumer panel was chaired by Todd A. Department of Health Policy & Li n s e n m e y e r , M.D., and consisted of nine mem Administration bers with experience in autonomic dysreflexia TeresaSchool Chase, of ND, Public RN Health University of North Carolina from varying health care professions. The recom Chapel Hill, North Carolina mendations are based on the world-wide research Kathleen Dunn,MS,RN information available on the topic. The panel Department of Rehabilitation Medicine was assisted by an expert team from the University of Washington School of Medicine Seattle, Washington University of North Carolina at Chapel Hill who Keri S. Jaeger, MBA,RN reviewed the literature and determined the qual Craig Hospital ity of the research. The Paralyzed Veterans of Englewood, Colorado Tom Mobley, PharmD America provided financial support and adminis trative resources for all aspects of guideline and VA San Diego Healthcare System San Diego, California consumer guide development. Inder Perkash,MD The guideline development process leads to Froedtert Memorial Lutheran Hospital Milwaukee, Wisconsin professional agreement on a topic. After the Cynthia Zejdlik,RN panel writes their guideline recommendations, James A. Haley Veterans Hospital many outstanding clinical and scientific experts Tampa, Florida review the draft guideline. The panel accepts or rejects the reviewers’ opinions by voting and pre Department of Veterans Affairs Medical Center pares the final guideline for legal review and ConsortiumPalo Alto, California Member Organizations editing. In the development of consumer guides, a consumer focus group of six or more spinal cord Independent Rehabilitation Nursing injured individuals reviews the guide with the Consultant Bellingham, Washington panel to make it more readable and easy to un d e r s t a n d . The Consortium for Spinal Cord Medicine is appreciative of the fine work of the guideline American Academy of Orthopedic Surgeons American Academy of Physical Medicine and development panel, the expert field reviewers, and Rehabilitation the writers, editors, and consultants that con American Association of Neurological Surgeons tributed to the content and quality. In particular, American Association of Spinal Cord Injury Nurses the Consortium would like to recognize the out American Association of Spinal Cord Injury Psychologists and Social Workers standing contribution by the American As s o c i a t i o n American Congress of Rehabilitation Medicine of Spinal Cord Injury Nurses (AASCIN) in provid American Occupational Therapy Association ing their consumer and family education material. American Paraplegia Society American Physical Therapy Association The Consortium will continue to develop clinical American Psychological Association practice guidelines and consumer guides on topics in American Spinal Injury Association spinal cord injury care. Look for consumer guides Association of Academic Physiatrists ii Association of Rehabilitation Nurses on other topics in spinal cord injury. Congress of Neurological Surgeons Insurance Rehabilitation Study Group Paralyzed Veterans of America U.S. Department of Veterans Affairs Who Should Read This Guide? ■ Quick Overview Autonomic dysr eflexia is ■ an emergency condition tha t needs immediate attention! It’s most likely to occur if People with spinal cord injury (SCI) at or you have a spinal cord in above T-6 jury at or above thoracic Their family, friends, and personal care level 6 (T-6). autonomic attendants Autonomic dysr eflexia is dysreflexia Health-care professionals may obtain a copy an abnormal response to a of the full clinical practice guideline by calling toll- problem somewhere in your free (888) 860-7244 or at www.pva.org. body. It's usually caused b y If you have SCI at or above T-6, this Guide is for a bladder or bowel problem. you. Why? Because you have a greater chance of developing a serious condition called Because of your SCI, your .* body can't respond properly If your injury is below T-6, this Guide may still to signals that something is be helpful. People with SCI as low as T-8 have Why Is This Guide Important? wrong. Instead, you may sometimes developed autonomic dysreflexia. develop a rapid rise in blood Even if you’ve already learned what to do for pressure. High blood pres - autonomic dysreflexia, you may want to keep this sure is a serious medical Guide for reference. It may be helpful for you or for people who share in your care. problem. It can cause a stroke and death.

Autonomic dysreflexia can be life-threatening. It requires quick and correct action. U n f o r t u n a t e l y, many health professionals aren’t familiar with this condition. That’s why it’s impor tant for you, and the people close to you, to learn about it. You may have to help guide your own treatment by ensuring that health-care profession als are thinking about autonomic dysreflexia when Whatthey are Is treatingAutonomic you. ThisDysreflexia? is true if you’re in an ambulance or at the hospital. It’s a good idea to keep this Guide handy. You may want to take it with you to the hospital and share it with the emergency room staff.

1 It’s an abnormal response to a problem in your body below your SCI. The cause is often an overfull bladder or bowel. Because of your SCI, your body *Words in italics are explained in the Glossary on page 10. 2

Here ’ s What HappensUTONOMIC inYSREFLEXIA HAT OU HOULD NOW A D : W Y S K Autonomic Dy s r efl e x i a can’t respond properly to signals that something is 1. Something is wrong. It’ s wrong. (Common warning signs that you might often an overfull bladder or have autonomic dysreflexia are listed below.) bowel. This causes your The important thing for you to know is that body to send messages to autonomic dysreflexia can be dangerous. It can cause a rapid rise in blood pressure. High blood your spinal cord. pressure is a serious medical problem. It can cause 2. Your spinal cord tries to a stroke and death. send the messages to your WhatThere Causes are two Autonomic ways you may Dysreflexia?get your blood pres brain. But your SCI blocks sure down: the messages from getting 1. Fix whatever is causing the problem through. (That’s why you 2. Special blood pressure medicines prescribed probably can’t feel the by your health-care professional pain.) 3. The messages to your Bladder problems are the number one cause of spinal cord “turn on” spe - autonomic dysreflexia. But any problem below your cial autonomic nerves. They SCI can cause this condition. make blood vessels in your WhSomea t Are of thethe moreMor ecommon Com m causeso n are listed in the legs and abdomen squeeze tableWar ning on pages Signs? 8–9. You can avoid most of these tight and get smaller . causes by taking good care of yourself. The table lists things you can do to prevent autonomic dysre 4. This squeezes extra blood flexia. into blood vessels in the rest of your body. The extr a

blood makes your blood ■ pressure go up fast. 5. Sensors near your brain Although it’s possible to have no symptoms, most people do. Watch for can tell that your blood one or more of the following more pressure is getting too common warning signs: high. They try to make your A fast, major increase in blood pressure is the blood pressure go down b y Important: most dangerous Individuals’ sign blood of autonomic pressures dysreflexvary. If sending out three signals: ia. A majoryou increasedon’t know is what20–40 your mm normal Hg higher than usual.blood Many pressure individuals is, it is important who have that SCI (continued) at or aboveyou T-6find have out. a blood pressure between 90 and 110 mm Hg systolic. (Systolic is the top number in a blood pres- 3

Here ’ s What Happens (continued) ■ UIDE FOR EOPLE ITH PINAL ORD NJURY ■ A G P W SignalS 1 C I tells your heart to slow down. (A slow heart beat is ■ called bradycardia.) sure reading.) Signal 2 A pounding headache goes to blood vessels in Heavy sweating, especially in your face, neck, ■ and shoulders. This is usually (but not always!) your face, neck, and upper above your spinal cord injury chest. It makes them get ■ Flushed or reddened skin, especially in your larger and hold more blood. ■ face, neck, and shoulders. This This can make you look ■ is usually above your flushed or red and blotchy . ■spinal cord injury Goose bumps, usually above Signal 3 your spinal cord injury tries to tell the blood ves - Blurry vision or seeing spots sels in your legs and A stuffyany nose abdomen to stop squeez - Anxiety or jitters ing. But your SCI blocks the A feeling of tightness in your messages from getting chest, flutters in your heart through. Your blood vessels or chest, or trouble breathing keep squeezing, and your If I WhileThink there I Have may Autonomic be other warning Dysreflexia, signs, these blood pressure stays high. areWhat the Shouldmore common. I Do? If of them appears, or if It may even keep rising. your blood pressure rises 20–40 mm Hg systolic, assume you have autonomic dysreflexia. Follow the stepsStep in the next section.

Important: You need to remain sitting or upright Promptuntil your action blood is pressure essential! is back If you to can’tnormal. follow Lyingthese downsteps mayyourself, make ask your someoneblood else pressure to do goso. up It’s higher important. to do these steps in the order below.

Step ■ ■

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Sit up or raise your head to 90 degrees. If you can lower your legs, do. Clothes Shoes or leg Loosen or take off anything tight:braces External catheter tape Leg bag straps 4

Bladder ■ ■ ManagementUTONOMIC YSREFLEXIATips HAT OUStep HOULD NOW A D : W Y S K ■ Drink enough fluids. Ask your health-care profes sional about the right Abdominal binders amount for you. You want Elastic hose to keep flushing out your or bandages Step bladder without letting it get overfull. If you have a blood pressure kit, ■ If your urine is cloudy, has take your blood pressure reading a bad smell, or has blood in See A about every 5 minutes it, call your health-car e to see if you’re getting professional right away . See B better. You probably have a bladder A. If you do intermittent catheterization, infection. Check oryour use bladder. an external catheter or ■ padding: Be careful with drinks tha t (below) if you do intermittent catheteriza have caffeine or alcohol. tion or use an external catheter. They can make your bladder (below) if you have an indwelling catheter fill up suddenly and cause you to get dehydr ated. ■ Checkups (often done year - ly) may include bladder 1. Take off the external catheter or pads. tests. Ask if your health 2. If you (or someone with you) has expe care professionals hav e rienceStop trying inserting to acatheterize catheter: your experience with autonomic bladder• Get a catheter. if: dysreflexia. Share this • Coat it with an anesthetic jelly (if information and make a available) or a lubricant jelly. plan with them be forehand. • Insert it and empty your bladder If you use intermittent promptly. catheterization: 3. ■ Stick to your schedule . • There’s no one with experience at Don't skip catheter inserting a catheter. sessions . • The catheter won’t slip in easily. • Your symptoms get worse.

(continued) Instead, call a health-care professional and go to the emergency room right away. Call 911 or have someone take you. It’s dangerous for you to drive if you have autonomic dysreflexia. 4. If you can insert another catheter and 5

Bladder Management Tips (continued) UIDE FOR EOPLE ITH PINAL ORD NJURY A G P W■ KeepS yourC fluidsI to about 8 ounces (1 cup, 240 ml) an hour. your blood pressure remains elevated, ■ If you drink more fluids go to the emergency room right away. B. If you have an indwelling catheter than usual, catheterize 5.(a FoleyCheck oryour suprapubic urine for blood, catheter): odor, or early or add an extr a cloudiness. If you find any of these session. things, call your health-care profes ■ sional right away. You probably have a Even though you may be bladder infection. tempted to cut back on fluids for convenience , don't. You’ll increase your risk for urinary tract 1. Check the tubing for kinks or twists. ge n - infection. If you find any, fix them. If the tubing is stretched or pulling, relax it. Then If you have an indwelling Important: tapeIf your it symptomsto keep it getfrom worse, pulling. im m e d i a t e l y catheter (a Foley or suprapubic stop irrigating. Call your health-care pro catheter): 2. Emptyfessional the and drainage go to the bag. emergency room ■ 3. Ifright there’ away!s no urine flow, and you have Check your drainage tube experience irrigating your bladder, after transfers and turns . tl y If you find any kinks or twists, fix them. Look for anything that clogs the catheter and clear it. ■ Make sure the drainage bag irrigate your bladder with saline doesn’t get more than half solution. Use a small amount: no more full. than 2 tablespoons or 1–2 ounces (30 cc). ■ Change your catheter regu 4. If there’s still no urine flow and some larly. Learn how to change one (you or anyone with you) has expe it yourself or make Stoprience trying inserting to catheterizea catheter: your bladder if: arrangements for someone • Get another catheter. to do it for you. Also, train • Coat it with an anesthetic jelly (if someone who can change it available) or a lubricant jelly. in an emergency . • Insert the catheter into your bladder. 5.

• There’s no one with experience at inserting a catheter. • The catheter won’t slip in easily. • Your symptoms get worse. Instead, call a health-care professional and go to the emergency room right 6

UTONOMIC YSREFLEXIA HAT OU HOULD NOW TalkA AboutD It : W Y S K Discuss autonomic dysr e flexia with your family, personal care attendants, and others away. Call 911 or have someone take who share in your car e. They you. It’s dangerous for you to drive if need to know how to recognize you have autonomic dysreflexia. it and help you if it occurs. And don't forget to bring up this 6. Check your urine for blood, odor, or subject with your health-car e Important:cloudiness. If you need If toyou go findto the any emergency of these professionals . things,room, callask yourif you health-care can sit up. Lyingprofes down sionalmay makeright away.your blood You probablypressure havego up. a If you're having tests , bladder infection. surgery, or a bab y, make sur e your health-care professionals are ready to monitor and man - Step age autonomic dysr eflexia if it develops.

7.If you can insert another catheter and your blood pressure remains high,Step go to the emergency room right away. If the warning signs go away, call your health-care professional anyway, to report the symptoms you had and what you did to Step correct the problem.

If the warning signs come back again, repeat these steps. Even if the warning ■signs go away again, call your health care professional and go to the emer gency room.

At the emergency room, make sure you: Tell the emergency room staff that you think you may have autonomic dysreflexia and need immediate treatment. 7

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UIDE FOR EOPLE ITH PINAL ORD NJURY A GA bloodP pressureW kit.S C I ■

Ask to have your blood with you at all times. Here’s what it ■ pressure should contain: A catheter and supplies. checked immediately.Step Request to keep sitting This can be cuff style or digital up as long as your blood style. Make sure that you—or some- pressure is high. one who can help in an emergency— knows how to use it. Ask the emergency room ■ staff to look for If■ you use intermittent catheteri zation, or use an external catheter or causes of ■ padding, pack a straight catheter. the problem. ■ Suggest that If you use an indwelling catheter, they check causes in this Anypack: prescription medicines you take for order: (1) bladder, (2) bowel, autonomican extra dysreflexia. catheter and (3) other causes. insertion supplies an irrigation syringe Use the diary form on pages 11 - Anestheticsterile or lubricantwater or jelly.saline solution 14 and in the back pocket of this Guide to keep a record of your What Goes in an Autonomic autonomic dysreflexia episodes. It A copyCheck of this their Guide. expiration dates and Dysreflexiacan be helpful Kit? to you and to your keep fresh supplies in your kit. health-care professionals.

Before you insert a catheter, coat it with the jelly.

AUTONOMIC DYSREFLEXIA IS AKeep MEDICAL your personal EMERGENCY! information It’s a goodYou idea need to make to recognize an "auto- it andcurrent. get the (See right the care A u tfast. o n o m i c nomic dysreflexia kit" and keep it Dysreflexia Diary on pages 11-14 8

Common Causes of Au tonomic Dys re f l ex i a UTONOMIC YSREFLEXIA HAT OU HOULD NOW WHATA CAUSESD IT : W Y S HOWK TO PREVENT IT BLADDER OR KIDNEY • Overfull bladder • Follow a reliable bladder management routine. • Problems such as urinary tract (See page 4, “Bladder Management Tip s . ” ) infection, or bladder or kidney • Checkups (often done yearly) may include stones bladder tests. Ask if your health-care profes • Bladder tests, treatments, or sionals have experience with autonomic dys surgery, such as cystoscopy and reflexia. Share this information and make a urodynamic tests plan with them beforehand.

BOWEL* OR ABDOMEN • Overfull bowel, constipation, or • Stick to your bowel program to prevent bowel blockage (impaction) constipation or bowel accidents. (If consti • Problems such as gallstones, pation is a problem, you may need to stomach ulcer or gastritis, hem change your bowel program.) orrhoids, or appendicitis • Work with your health-care professional to • Bowel or abdominal tests or determine what your usual fiber intake is. surgery, such as sigmoidoscopy Any increase in fiber intake should be or barium enema done gradually, from a wide variety of sources, and be monitored by a health care professional. • Drink plenty of fluids. Ask your health-care professional about the right amount for you and your bladder program. • Checkups (often done yearly) may include bowel tests. Ask if your health-care profes sionals have experience with autonomic dysreflexia. Share this information and make a plan with them beforehand. * For more detailed information on bowel care, a complete bowel management clinical practice guideline is available at the website: www.pva.org or by calling toll-free (888) 860-7244. SKIN • Pressure sores (pressure • Check your skin at least once a day for red ulcers) spots, scrapes, or scratches below your • Problems such as ingrown toe SCI. If you find any, call your health-care nails, burns (including sun professional right away. burns), or insect bites • Try to avoid situations where you’re likely to • Contact with hard or sharp get burns, cuts, scrapes, or other injuries. things or other injuries to the • Keep sharp or harmful things out of your skin bed and wheelchair. • Make sure your clothes, shoes, appliances, and braces fit comfortably. Be especially careful if they’re new. 9

UIDE FOR EOPLE ITH PINAL ORD NJURY WHAT CAUSES IT A GHOW TOP PREVENTW S ITC I SEXUAL ACTIVITY OR REPRODUCTION • Too much genital stimulation, espe • Be aware that these activities and con cially using a vibrator ditions are possible causes of autonom • Men: ejaculation, infection or inflam ic dysreflexia. You may want to discuss mation of the testicles (epididymi these issues with your health-care tis), or pressing or squeezing of the p r o f e s s i o n a l . testicles • If you’re pregnant or planning a preg • Women: menstruation, pregnancy nancy, look for an obstetrician/gynecol (especially labor and delivery), or ogist who’s willing to work with you and infections of the vagina (vaginitis) with other health-care professionals or uterus (pelvic inflammatory who know your SCI care. disease)

OTHER CAUSES • Clots in the leg or pelvis veins • Recognize that all these problems can (deep vein thrombosis) that may cause autonomic dysreflexia. Alert your travel to the lungs (pulmonary health-care professionals and share emboli)* this information with them. • Broken bones or other injuries • Make sure your clothes, shoes, appli • Everyday problems such as too- ances, and braces fit comfortably. tight clothing, shoes, appliances, or • Try to avoid extremes in temperature. braces Plan to dress appropriately. • Extreme temperatures (too hot or too cold), or quick temperature changes

* For more detailed information on deep vein thrombosis (thromboembolism), a complete Prevention of Thromboembolism clinical practice guideline is available at the website: www.pva.org or by calling toll-free (888) 860-7244. Glossary autonomicand in the back dysreflexia pocket of this Guide.) Be sure to discuss your autonomic dysreflexia kit with your health-care professional. Ask if you should include other supplies. Also ask if your health-careautonomic professionalnerves can give you prescriptions for items in the kit. barium enema —An abnormal response to a problem in the body below a spinal cord injury. It’s most likely to happen if the SCI is at or above the 6th thoracic vertebra (T-6). bradycardia —Nerves in the spinal system that control involuntary cystoscopy action. —An examination of the inside of the body done with a sub deep vein thrombosis stance called "barium." This test is also called a "double-contrast exami nation." epididymitis —Slow heart rate, usually fewer than 60 beats per minute. —An examination of the inside of the bladder and ureter. It’s gastritis done with an instrument called a "cystoscope." impaction (of the bowel) —Clots in the leg or pelvis veins. Also referred to as “thromboembolism.” pelvic inflammatory disease (PID) —Inflammation of the part of the testicle called the "epi didymis." pulmonary emboli —Inflammation of the stomach. sigmoidoscopy —Occurs when hard stool is stuck in the rectum or somewhere else in the bowel. —An infection anywhere in a woman’s genital tract above the cervix. —Blood clots that travel to the lungs. —An examination of the part of the colon called the "sigmoid

10 My Personal Autonomic Dysreflexia Diary

This Personal Diary is intended for you to use to keep a health-care record of your episodes of autonomic dysreflexia. Another copy of the Diary, which you can photo copy for re-use, appears in the back pocket of this Guide. Keep this diary and the Guide with you.

Name:

Address:

City State: Zip Code:

SymptomsPhone Number: ( )

Social Security Number: Date of Birth: ❒ ❒ Date❒ of Dysreflexia Episode: ❒ ❒ Put ❒a checkmark or "X" next to every symptom you have for each dysreflexia episode. ❒ ❒ Pounding headache Tight chest ❒ Heavy sweating Trouble breathing ❒ Flushed skin Other: Goose bumps Blurry vision Seeing spots Stuffy nose Anxiety or jitters

Cause of Dysreflexia Episode and Comments:

11 Symptoms

❒ ❒ ❒ ❒ Date of Dysreflexia Episode: ❒ ❒ Put❒ a checkmark or "X" next to every symptom you have for each dysreflexia episode. ❒ Pounding headache Tight chest ❒ Heavy sweating Trouble breathing ❒ Flushed skin Other: Goose bumps Blurry vision Seeing spots Stuffy nose Anxiety or jitters

Cause of Dysreflexia Episode and Comments:

Symptoms

❒ ❒ ❒ ❒ Date of Dysreflexia Episode: ❒ ❒ Put ❒a checkmark or "X" next to every symptom you have for each dysreflexia episode. ❒ Pounding headache Tight chest ❒ Heavy sweating Trouble breathing ❒ Flushed skin Other: Goose bumps Blurry vision Seeing spots Stuffy nose Anxiety or jitters

Cause of Dysreflexia Episode and Comments: 12 Symptoms

Cause of Dysreflexia Episode and Comments:

Symptoms

Cause of Dysreflexia Episode and Comments: 13 MEDICAL HISTORY

Date of Spinal Cord Injury:

Neurologic Location of Injury:

Normal Blood Pressure:

Blood Type:

Primary Health-care Professional: EMERGENCY INFORMATION Phone Number:

Medications:

In Case of Emergency, Call: INSURANCE INFORMATION Relationship:

Phone Number: ( )

Name of Insurance Company:

Identification Number:

Group Number:

Phone Number: ( )

Plan Subscriber: 14