Difference between revisions of "Neurogenic shock"

Line 1: Line 1:
 
==Background==
 
==Background==
Hypotension & bradycardia
+
*Diagnosis of exclusion
 
+
**Never presume hypotension in trauma patient is due to neurogenic shock
Results from disrupted sympathetic flow w/ overriding vagal tone
+
*Injury to cervical or thoracic vertebrae causes peripheral sympathetic denervation
 
+
**Above T1:  full
===Sympathetic Disruption===
+
**T1-L3:  Partial
#Above T1:  full
+
**Below L4:  none
#T1-L3:  Partial (higher=more)
+
*Lasts 1-3 wk
#Below L4:  none
 
#Lasts = 1-3 wks
 
 
 
^beware of hypothermia
 
  
 
==Diagnosis==
 
==Diagnosis==
(high thoracic or cervical injury)
+
*Hypotension (well tolerated)
#mild hypotension
+
*Bradycardia
#bradycardia
+
*Peripherally vasodilated (warm extremities)
#warm periferal extremities
+
**May lead to hypothermia
#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)
+
#Exclude other causes of shock
# IVF (SBP goal >70)
+
#IVF (MAP goal >90)
##use neosynephrine/ Levophed
+
#Pressors if needed
# Atropine (if sypm brady)
+
#Atropine if needed
# Keep warm
+
#Keep warm
  
 
==Prognosis==
 
==Prognosis==
If cord is contused and not transected, bulbocavernosus refex should return w/in 24-48 hrs
+
*If cord is contused, not transected, prognosis is good
 +
**Bulbocavernosus reflex should return w/in 24-48 hr
  
 
==Source ==
 
==Source ==
2/06 DONALDSON (Adapted from Tintinalli)
+
*Tintinalli's
  
 
[[Category:Neuro]]
 
[[Category:Neuro]]
 
[[Category:Trauma]]
 
[[Category:Trauma]]

Revision as of 22:11, 12 July 2011

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