Neurogenic shock

Revision as of 19:02, 5 January 2016 by Kxl328 (talk | contribs)

Background

  • Do not confuse with Spinal Shock
  • 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 sympathetic denervation
    • T1-L3: Partial sympathetic denervation
    • Below L4: no sympathetic denervation
  • Lasts 1-3 wk

Diagnosis

  • Hypotension (well tolerated)
  • Bradycardia
  • Peripherally vasodilated (warm extremities)
    • May lead to hypothermia

Differential Diagnosis

Shock

Treatment

  1. Exclude other causes of shock
  2. Supplemental O2 to perfuse injured spinal cord
  3. Mechanical ventilation and oxygenation if spinal perfusion is compromised
  4. Judicious IVF, with SBP goal >90-100 mmHg
  5. Pressors if needed, norepinephrine or dopamine
  6. Atropine if needed, keeping HR 60-100 bpm in NSR
  7. UOP > 30 cc/hr
  8. Prevent hypothermia

Source

See Also