Neurogenic shock

Question 1

General findings

In a patient who develops hypotension following high-energy trauma, neurogenic shock is a diagnosis of exclusion that is made after hypovolemic and obstructive cardiogenic shock have been ruled out!

Answer 1

Loss of sympathetic vascular tone → peripheral vasodilation → pooling of peripheral blood (warm skin)

Question 2

Etiology

Answer 2

• Spinal cord injury
• Spinal anesthesia
• Traumatic brain injury
• Cerebral hemorrhage
• Poisoning
• Severe pain

Question 3

Clinical features

La bradicardia è tipica dello shock spinale, dell’ ipertensione endocranica e della trombosi venosa centrale!👓

HYPOREFLEXIA! (come Guillame Barrè)

Answer 3

• Flushed, warm skin
• Bradycardia
• Hypotension with a normal pulse pressure (proprio perchè manca l’attività neurogenica non c’è alcuna risposta simpatica con tachicardia)
• Clinical features of the underlying cause, i.e. toxidromes or neurological deficits (e.g., loss of spinal reflexes)

Question 4

Treatment

Answer 4

1.Fluid resuscitation
2.Atropine to treat bradycardia
If fluid resuscitation fails to increase MAP beyond 90 mm Hg
-If bradycardia is absent: phenylephrine
-If bradycardia is present: epinephrine💥