Neurogenic shock is a type of distributive shock that produces low blood pressure, sometimes with a slow heart rate, associated with an autonomic line disorder in the spinal cord. This can occur after damage to the central nervous system, such as spinal cord injury. Low blood pressure occurs due to a decrease in systemic vascular resistance resulting in blood collection in the extremities lacking sympathetic tones. Slow rate of heartbeat results from vagal activity not found and has been found to be aggravated by hypoxia and endobronchial suction. Neurogenic shock may be a potentially destructive complication, leading to organ dysfunction and death if not promptly recognized and treated. It does not become confused with spinal shock, which is not circulatory.
Video Neurogenic shock
Signs and symptoms
Because it causes loss of sympathetic tones, which play a major role in other forms of shock, neurogenic shock leads to a unique and unspecific presentation.
Usually, in other forms of shock, the sympathetic nervous system triggers various compensatory mechanisms by releasing epinephrine and norepinephrine, the main chemical mediator. These neurotransmitters trigger an increase in heart rate, faster breathing, and sweating. They also trigger vasoconstriction, to avoid blood from the extremities and to the vital organs.
In neurogenic shock, the body loses its ability to activate the sympathetic nervous system and can not trigger this compensatory mechanism. Only the remaining parasympathetic tone. As a result, the unique presentation of neurogenic shock includes:
- immediate hypotension due to sudden, massive vasodilation
- Warm, skin reddened by vasodilation and vasoconstrict disability
- Priapism, also because of vasodilation
- Patients will not be able to experience tachycardia, and may become bradycardic
- If the injury is below the 5th cervical vertebra, the patient will show diaphragmatic breathing due to loss of nerve control in the intercostal muscle (required for chest breathing).
- If the injury is above the 3rd cervical vertebra, the patient will have immediate respiratory surgery after the injury, due to loss of nerve diaphragm control.
Maps Neurogenic shock
Cause
Neurogenic shock may result from severe central nervous system damage (brain, cervical or thoracic spinal cord injury). In simpler terms: trauma causes a sudden loss of sympathetic background stimulation in the blood vessels. This causes them to relax (vasodilatation) resulting in a sudden drop in blood pressure (due to decreased peripheral vascular resistance).
Neurogenic shock results from spinal cord damage above the level of the sixth thoracic spine. Found in about half of people with spinal cord injuries within the first 24 hours, and usually do not disappear for one to three weeks.
Diagnosis
Treatment
- Dopamine (Intropin) is often used alone or in combination with other inotropic agents.
- Vasopressin (antidiuretic hormone [ADH])
- Certain vasopressors (ephedrine, norepinephrine). Phenylephrine can be used as a first-line treatment, or secondary in people who do not respond adequately to dopamine.
- Atropine is given for a slowed heartbeat.
References
External links
Source of the article : Wikipedia
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