| Neurogenic Shock |
Pathophysiology
- Spinal cord injuries T6 and above
- Form of distributive shock due to:
- Disruption of sympathetic outflow from T1-L2 and unopposed vagal (parasympathetic) tone
- Decreased systemic vascular resistance with pooling of blood
Clinical manifestations
- Warm extremities and bounding peripheral pulses with hypotension and evidence of end-organ dysfunction (e.g. oliguria, depressed mental status)
- May have bradycardia
- NOT to be confused with spinal shock
Treatment:
Note: Caution when using phenylephrine in injuries T4 and above as it often causes reflexive bradycardia possibly worsening spinal cord injury associated bradycardia
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| Spinal Shock |
Pathophysiology
- Complete loss of motor, sensory, reflex (including rectal tone), and autonomic function below the specific level of injury
Clinical manifestations
- Transient — can begin 30-60 minutes following a spinal cord injury and last up to six weeks post-injury
- NOT to be confused with neurogenic shock
Pay close attention to changes in rectal tone |
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| Respiratory Support |
- Rapid Sequence Intubation (RSI):
- Goals:
- SpO2 > 92% and < 98%
- EtCO2: 30-34 mmHg
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- Etomidate
- Appropriate for patients with multiple-traumatic injuries or tenuous hemodynamics
- Lasts for approximately 8 minutes — consider the need for additional sedation but avoid hypotension
- Propofol and thiopental may exacerbate hypotension resulting from hemorrhage and/or neurogenic shock
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| Temperature Instability |
Pathophysiology
- Injuries T6 and above
- Disruption of afferent input to thermoregulatory centers and impaired control of the distal sympathetic nervous system:
- Unable to increase core temperature by vasoconstriction and shivering
- Unable to decrease core body temperature by vasodilatation and sweating below the SCI
Treatment
- Temperature control, including ambient temperature and/or warmed IVF/blood products
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