Neurogenic shock
Pathophysiology
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
1) EXCLUDE other causes of shock (i.e. hemorrhage, PNTX, tampand)
2) IVF (SBP goal >70)
-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)