Difference between revisions of "Neurogenic shock"

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==Pathophysiology==
+
==Background==
 
 
 
 
 
Hypotension & bradycardia
 
Hypotension & bradycardia
  
*Results from disrupted sympathetic flow w/ overriding vagal tone
+
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
+
===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
-mild hypotension
+
#bradycardia
 
+
#warm periferal extremities
-bradycardia
+
#loss of neuro func below injury level
 
+
#Flaccid paralysis/Areflexia
-warm periferal extremities
+
#priapism, Horner's, & abd breathing
 
 
-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)
1)  EXCLUDE other causes of shock (i.e. hemorrhage, PNTX, tampand)
+
##use neosynephrine/ Levophed
 
+
# Atropine (if sypm brady)
2)  IVF (SBP goal >70)
+
# Keep warm
 
 
    -use neosynephrine/ Levophed
 
 
 
3)  Atropine (if sypm brady)
 
 
 
4)  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

  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)