Neurogenic shock

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Background

Hypotension & bradycardia

Results from disrupted sympathetic flow w/ overriding vagal tone

Sympathetic Disruption

  1. Above T1: full
  2. T1-L3: Partial (higher=more)
  3. Below L4: none
  4. Lasts = 1-3 wks

^beware of hypothermia

Diagnosis

(high thoracic or cervical injury)

  1. mild hypotension
  2. bradycardia
  3. warm periferal extremities
  4. loss of neuro func below injury level
  5. Flaccid paralysis/Areflexia
  6. priapism, Horner's, & abd breathing

Treatment

  1. EXCLUDE other causes of shock (i.e. hemorrhage, PNTX, tampand)
  2. IVF (SBP goal >70)
    1. use neosynephrine/ Levophed
  3. Atropine (if sypm brady)
  4. 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)

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