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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)
- However, this leads to hypothermia
- Ensure monitoring of core temperatures and warming of patient
Differential Diagnosis
Treatment
- Exclude other causes of shock
- Supplemental O2 to perfuse injured spinal cord
- Mechanical ventilation and oxygenation if spinal perfusion is compromised
- Prevent hypothermia
- Judicious IVF, with UOP > 30 cc/hr
- Norepinephrine first line, with MAP goal of 85-90 for the first 7 days after spinal cord injury[1]
- Consider adding phenylephrine if BP refractory to first line agent
- Phenylephrine alone without beta-1 stimulation will cause reflex bradycardia
- Atropine if needed, keeping HR 60-100 bpm in NSR
- May titrate down on norepinephrine and atropine, to favor more phenylephrine alpha agonism in ICU setting
Source
See Also