Chapter 25: Shock- Neurogenic Flashcards
What is the definition?
Inadequate tissue perfusion from loss of sympathetic vasoconstrictive tone
What are the common causes?
Spinal cord injury:
- Complete transection of spinal cord
- Partial cord injury with spinal shock
- Spinal anesthesia
What are the signs/symptoms?
Hypotension and bradycardia, neurologic deficit
Why are heart rate and BP decreased?
Loss of sympathetic tone (but hypovolemia [e.g., hemoperitoneum] must be ruled out)
What are the associated findings?
Neurologic deficits suggesting cord injury
What MUST be ruled out in any patient where neurogenic shock is suspected?
Hemorrhagic shock!
What is the treatment?
IV fluids (vasopressors reserved for hypotension refractory to fluid resuscitation)
What is spinal shock?
Complete flaccid paralysis immediately following spinal cord injury; may or may not be associated with circulatory shock
What is the lowest reflex available to the examiner?
Bulbocavernous reflex: checking for contraction of the anal sphincter upon compression of the glans penis or clitoris
What is the lowest level voluntary muscle?
External anal sphincter
What are the classic findings associated with neurogenic shock?
- Hypotension
- Bradycardia or lack of compensatory tachycardia
What is the acronym for treatment options for anaphylactic shock?
“BASE”:
- Benadryl
- Aminophylline
- Steroids
- Epinephrine
What is the treatment?
15-year-old s/p trampoline injury with tetraplegia (a.k.a.“quadriplegia”) with hypotension. No other injuries on CT scans
Neurogenic shock; treat with IV fluids and then vasopressors as needed
