What is the first step in the management of autonomic dysreflexia?

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Autonomic dysreflexia is a potentially life‑threatening reaction that occurs in people with high spinal cord injuries when a noxious stimulus below the injury triggers a massive, unopposed sympathetic response. The first management step is to identify and remove the triggering stimulus because eliminating the source stops the afferent signal driving the crisis. Common triggers include bladder distension from a blocked catheter or full bladder, stool impaction, tight clothing, or skin pressure. Quickly check the urinary catheter for patency and drain or replace as needed, assess for impaction and relieve it, and remove any constrictive garments. At the same time, place the patient in a sitting position to help lower blood pressure. If hypertension persists after removing the stimulus, activate protocol for rapid-acting antihypertensives (for example, sublingual nifedipine or intravenous agents) and continue close monitoring.