Neurogenic shock

Background

• 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
  • T1-L3: Partial
  • Below L4: none
• 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

Prognosis

• If cord is contused, not transected, prognosis is good
  • Bulbocavernosus reflex should return w/in 24-48 hr

Source

• Tintinalli's

See Also

• Spinal Cord Trauma
• Spinal Cord Compression (Non-Traumatic)
• Autonomic Dysreflexia