Neurogenic Shock: 23 September 2016

Neurogenic shock
23 September 2016
Neurogenic shock is shock caused by the sudden loss of the
autonomic nervous system signals to the smooth muscle in
vessel walls --> result from severe central nervous system
(brain and spinal cord) damage.
- Neurogenic shock occurs after an injury to the spinal cord.
- Sympathetic outflow is disrupted resulting in unopposed
vagal tone.
- The major clinical signs are hypotension and bradycardia
The most commonly affected area:
cervical region, followed by the thoracolumbar junction, the thora
- Clinical clues such as hypotension, bradycardia, neurologic
dysfunction, and warm, dry skin may lead the clinician to
suspect neurogenic shock
- however, only after other injuries have been identified and
treated can the diagnosis of neurogenic shock safely be
made
https://emergencymed.wordpress.com/2009/03/11/neurogenic-shock/
extreme pain causes neurogenic shock by overexciting the
parasympathetic nervous system --> causes the heart rate to
slow too much leading to a dangerous drop in blood pressure
and, hence, shock -- maybe even death.
- Pain stimulates the autonomic nervous system, both
sympathetic and parasympathetic.
- Normally in adults, sympathetic stimulation dominates, hence,
we commonly encounter tachycardia and hypertension in
response to pain
- In paediatric age group or in adults with autonomic dysfunction,
catecholamine depleted state or vagal hyperactivity, the same
stimulus may produce a response that is dominated by
parasympathetic stimulation and hence may lead to symptoms
of parasympathetic stimulation like bradycardia, asystole,
bronchospasm and laryngospasm.
- Typical examples of this parasympathetic activation includes
some common reflexes encountered during anaesthesia like the
Brewer-Luckardt reflex, Bezold-Jarisch reflex and the ventricular
mass reflexes that produce cardiac arrest in oterwise healthy
young adults during spinal anaesthesia
- Neurogenic shock is classically characterised by
hypotension, bradycardia and peripheral vasodilatation.
- Neurogenic shock is due to loss of sympathetic vascular tone
and happens only after a significant proportion of the
sympathetic nervous system has been damaged – as may
occur with lesions at the T6 level or higher.
- Spinal shock is not a true form of shock.

- It refers to the flaccid areflexia that may occur after spinal
cord injury, and may last hours to weeks.
- It may be thought of as ‘concussion’ of the spinal cord and
resolves as soft tissue swelling improves.
- Priapism may be present.
EMERGENCY DEPARTMENT CARE AND DISPOSITION
The initial evaluation and care of the patient with potential neurogenic shock is the
same as for all trauma patients, that is, rapid identification and stabilization of life-
threatening injuries.
- Airway control should be insured with spinal immobilization and protection.

- Crystalloid IV fluids should be infused to maintain a mean arterial blood pressure
above 70 torr. To prevent excessive fluid administration, a pulmonary artery
catheter may be placed to monitor hemodynamic response. If fluid resuscitation is
inadequate to insure organ perfusion, inotropic agents such as dopamine 2.5 to
20.0 µg/kg per min and dobutamine 2.0 to 20.0 µg/kg per min may be added to
improve cardiac output and perfusion pressure. The doses should be titrated to
the appropriate clinical response.
- If necessary, severe bradycardia may need to be treated with atropine 0.5 to 1.0
mg IV (every 5 min for a total dose of 3.0 mg) or with a pacemaker.
- In the presence of neurologic deficits, high-dose methylprednisolone therapy
should be instituted within 8 h of injury. A 30 mg/kg bolus should be administered
over 15 min followed by a continuous infusion of 5.4 mg/kg per h for the next 23
h.
- Trauma surgery, neurosurgery, and orthopedic consultation should be obtained
and arrangement made for transfer if necessary.
https://emergencymed.wordpress.com/2009/03/11/neurogenic-shock/
Thank You

Neurogenic Shock: 23 September 2016

Uploaded by

Copyright:

Available Formats

Neurogenic Shock: 23 September 2016

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Neurogenic Shock: 23 September 2016

Uploaded by

Copyright:

Available Formats

Neurogenic shock

- Spinal shock is not a true form of shock.

- Airway control should be insured with spinal immobilization and protection.

You might also like