Neurogenic shock: Difference between revisions

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**Never presume hypotension in trauma patient is due to neurogenic shock
**Never presume hypotension in trauma patient is due to neurogenic shock
*Injury to cervical or thoracic vertebrae causes peripheral sympathetic denervation
*Injury to cervical or thoracic vertebrae causes peripheral sympathetic denervation
**Above T1:  full
**Above T1:  full sympathetic denervation
**T1-L3:  Partial
**T1-L3:  Partial sympathetic denervation
**Below L4:  none
**Below L4:  no sympathetic denervation
*Lasts 1-3 wk
*Lasts 1-3 wk


Revision as of 03:57, 7 May 2012

Background

  • Do not confuse with Spinal Shock
  • Diagnosis of exclusion
    • Never presume hypotension in trauma patient is due to neurogenic shock
  • Injury to cervical or thoracic vertebrae causes peripheral sympathetic denervation
    • Above T1: full sympathetic denervation
    • T1-L3: Partial sympathetic denervation
    • Below L4: no sympathetic denervation
  • Lasts 1-3 wk

Diagnosis

  • Hypotension (well tolerated)
  • Bradycardia
  • Peripherally vasodilated (warm extremities)
    • May lead to hypothermia

Treatment

  1. Exclude other causes of shock
  2. IVF (MAP goal >90)
  3. Pressors if needed
  4. Atropine if needed
  5. Keep warm

Source

  • Tintinalli

See Also

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