Neurogenic shock: Difference between revisions
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==Treatment== | ==Treatment== | ||
#Exclude other causes of shock | #Exclude other causes of shock | ||
#IVF | #Supplemental O2 to perfuse injured spinal cord | ||
#Pressors if needed | #Mechanical ventilation and oxygenation if spinal perfusion is compromised | ||
#Atropine if needed | #IVF, with SBP goal >90-100 mmHg | ||
# | #Pressors if needed, norepinephrine or dopamine | ||
#Atropine if needed, keeping HR 60-100 bpm in NSR | |||
#UOP > 30 cc/hr | |||
#Prevent hypothermia | |||
==Source == | ==Source == | ||
Revision as of 19:00, 5 January 2016
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
Differential Diagnosis
Shock
- Cardiogenic
- Acute valvular Regurgitation/VSD
- CHF
- Dysrhythmia
- ACS
- Myocardial Contusion
- Myocarditis
- Drug toxicity (e.g. beta blocker, CCB, or bupropion OD)
- Obstructive
- Distributive
- Hypovolemic
- Severe dehydration
- Hemorrhagic shock (traumatic and non-traumatic)
Treatment
- Exclude other causes of shock
- Supplemental O2 to perfuse injured spinal cord
- Mechanical ventilation and oxygenation if spinal perfusion is compromised
- IVF, with SBP goal >90-100 mmHg
- Pressors if needed, norepinephrine or dopamine
- Atropine if needed, keeping HR 60-100 bpm in NSR
- UOP > 30 cc/hr
- Prevent hypothermia
Source
- Tintinalli