Neurogenic shock: Difference between revisions
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== | ==Background== | ||
Hypotension & bradycardia | Hypotension & bradycardia | ||
Results from disrupted sympathetic flow w/ overriding vagal tone | |||
===Sympathetic Disruption=== | |||
#Above T1: full | |||
#T1-L3: Partial (higher=more) | |||
#Below L4: none | |||
#Lasts = 1-3 wks | |||
^beware of hypothermia | |||
==Diagnosis== | ==Diagnosis== | ||
(high thoracic or cervical injury) | (high thoracic or cervical injury) | ||
#mild hypotension | |||
#bradycardia | |||
#warm periferal extremities | |||
#loss of neuro func below injury level | |||
#Flaccid paralysis/Areflexia | |||
#priapism, Horner's, & abd breathing | |||
==Treatment== | ==Treatment== | ||
# EXCLUDE other causes of shock (i.e. hemorrhage, PNTX, tampand) | |||
# IVF (SBP goal >70) | |||
##use neosynephrine/ Levophed | |||
# Atropine (if sypm brady) | |||
# Keep warm | |||
==Prognosis== | ==Prognosis== | ||
If cord is contused and not transected, bulbocavernosus refex should return w/in 24-48 hrs | If cord is contused and not transected, bulbocavernosus refex should return w/in 24-48 hrs | ||
==Source == | ==Source == | ||
2/06 DONALDSON (Adapted from Tintinalli) | 2/06 DONALDSON (Adapted from Tintinalli) | ||
[[Category:Neuro]] | [[Category:Neuro]] | ||
[[Category:Trauma]] | |||
Revision as of 07:39, 28 March 2011
Background
Hypotension & bradycardia
Results from disrupted sympathetic flow w/ overriding vagal tone
Sympathetic Disruption
- Above T1: full
- T1-L3: Partial (higher=more)
- Below L4: none
- Lasts = 1-3 wks
^beware of hypothermia
Diagnosis
(high thoracic or cervical injury)
- mild hypotension
- bradycardia
- warm periferal extremities
- loss of neuro func below injury level
- Flaccid paralysis/Areflexia
- priapism, Horner's, & abd breathing
Treatment
- EXCLUDE other causes of shock (i.e. hemorrhage, PNTX, tampand)
- IVF (SBP goal >70)
- use neosynephrine/ Levophed
- Atropine (if sypm brady)
- Keep warm
Prognosis
If cord is contused and not transected, bulbocavernosus refex should return w/in 24-48 hrs
Source
2/06 DONALDSON (Adapted from Tintinalli)