Neurogenic shock

Revision as of 22:11, 12 July 2011 by Jswartz (talk | contribs)

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