Autonomic dysreflexia (AD) is a well known potential complication following SCI. However, recent research has demonstrated that AD is far more common than previously believed, occurring an average of 11 times per day in patients with high tetraplegia. These findings are troubling when paired with emerging evidence that AD has serious implications for neuroendocrine systems, immunosuppression, and cardiovascular disease development. We will discuss these issues and highlight a recently published, high-efficacy treatment algorithm for AD. We will also discuss new research on the pharmacodynamics of nitroglycerin ointment, providing guidance to providers on when to expect a response (and escalate care if needed). We will further highlight the role of bladder-induced AD, explain emerging evidence for the underlying pathophysiology, and discuss the findings supportive that nitrogoglycerin ointment has a duel mechanism and improved efficacy in bladder-induced AD. Finally, we will discuss how lidocaine, blocking primary afferents, can decrease the risk of AD in routine catheter change. We will then summarize these take home lessons for the audience and open the forum to questions.