 If you haven't already done so, please watch the other video that actually discusses the mechanism of injury and the signs and symptoms and treatment and nursing care of spinal cord injury in a separate video. Automatic hyperreflexia is also a life-threatening injury as is neurogenic shock. And what happens here is now the sympathetic nervous system below the level of the injury responds to a stimulus of the sensory receptors. And this can be as simple as a wrinkled sheet that the patient is laying on. And this then leads to basic constriction because now we're hyper-stimulating the sympathetic nervous system and the reflexes, the primitive reflexes it controls. And because of this basic constriction now, we'll constrict the blood vessels, the blood pressure goes up and it can be as high as 300 millimeters of mercury and you can imagine how that can be life-threatening to all the different organs. And then there's no opposition from the parasympathetic nervous system because we have that spinal cord injury. There is no communication. But the barrel receptors that sit in the carotid arteries and in the aortic arch, they stimulate the parasympathetic nervous system, which is kind of like the backup system in case the brain of the spinal cord can't communicate. And that leads to a hypo-brainic heart failure. But there is no basic dilation because of that spinal cord injury. So usually the barrel receptors would simulate the parasympathetic nervous system, heart rate goes down, peripheral blood vessels dilate. But now because the sympathetic nervous system is so overly excited, it continues to raise a constrict. So now we have a problem with low heart rate and high blood pressure. So quite the opposite that we have over here with the super low blood pressure. And the most common causes for high autonomic hypo-reflexia are the standard bladder and bowel. And this is something that usually comes up on an exam, I'll tell you that right away. But it can also be due to skin or pain receptor stimuli. And like I said before, this could be as simple as a wrinkled sheet that's putting a pressure or maybe the patient just rolls over and they inadvertently lay on the car light. Any kind of stimulus that can send their sympathetic nervous system into overdrive because the function is impaired. Now signs and symptoms here is because of this extremely high blood pressure, the patient will also have a throbbing headache and maybe blurry vision as often goes along with high blood pressure. There might be diaphoresis above the level of the spinal cord injury because that's still functioning normally. And then we have a low heart rate, sometimes in the 30s and 40s. There might be pylorection, which basically means goosebumps above and flushing above the level of the injury. And the treatment for this life-threatening autonomic hyperreflexia is to check the blood pressure right away if the patient complains of a headache. So if you're treating a patient with a spinal cord injury, no matter if this is right after the injury while they're still in the hospital, while they're in rehab, or maybe even if they've been discharged and they've been home for a year or two because this can certainly occur at any time. And then we want to elevate the head of the bed to help with the vasodilation here. And then we certainly have to determine the cause. So if the most common causes are bladder and bowel dissension, then we have to relieve that by maybe catheterizing the patient or helping them get rid of any fecal impaction. And then removing any skin stimuli such as, you know, like I talked about the wrinkle or the coleta that they might be laying on. But also in order to control this really, really elevated blood pressure, we might need vasodilators such as nitroglycerin, nitroprosyline, and sometimes hydrolysin is also used.