Neurogenic Shock

Spinal Cord Injury

Trauma or injury to the spinal cord can cause a disruption in the sympathetic tone, which causes unopposed parasympathetic tone.

Causes:

Spinal Anesthesia

Causes

The improper administration of anesthesia to the spinal cord can cause neurogenic shock.

This would include an overdosing of anesthesia and anesthesia into the spinal cord itself instead of into the spinal column.

Example would be an epidural into the spinal cord instead of spinal column.

These are the three major causes of neurogenic shock,

Depressant actions of medications

Medications that affect the autonomic nervous system, which regulates breathing and other automatic bodily functions.

Dry, warm skin

Clinical Manifestions

Hypotension and bradycardia

These are the first signs of neurogentic shock.

Clinical Manifestations

diaphragmatic breathing and respiratory arrest

Complications:

Complications

• Autonomic dysreflexia related to venous and arterial dilation
• Spinal cord ischemia
• DVT
• Cardiovascular collapse
• End organ damage and dysfunction including acute kidney injury
• Acidemia
• Myocardial depression
• Hypotension
• Multiorgan failure.

IV Fluids:

Crystaloid fluids (stabilize bp)

Pharmalogical treatment

Atropine:

Severe bradycardia

Steriods:

Neurological deficit

Medications

These are some of the medications that are implemented in the treatment of neurogenic shock

Inotropic agents/vasopressors: Fluid resuscitation and stabilize VS

Surgery:

Stabilization of vertebral column and decompression of spinal cord; timing of surgical intervention is dependent on hemodynamic stability; within 72 hours is goal

Other Treatments

Other treatments

These are other treatments that are utilized in treating neurogenic shock

Medical Management:

- restoring sympathetic tone (stabilizing the spinal cord injury or positioning the patient properly due to spinal anesthesia)

- immobilization (using traction to stabilize the spine into proper alignment)

Radiology:

- CT

- X-ray

- MRI

Tests:

Tests

These are some of the tests that are implemented to assist with the diagnosis of neurogenic shock.

Labs:

- Hemoglobin level test and hematocrit results may be normal b/c hypotension is not caused by hypovolemia but the results can be decreased in there is blood loss r/t spinal cord injury trauma.

- CMP to reveal electrolyte and renal function abnormalities d/t tissue hypoperfusion.

-Coagulation panel may reveal coagulopathy in traumatic brain injury

O2 as ordered

Air mattress

Considerations:

Spinal immobilization

Considerations

Mediation administration

TPN maintenance

Pulmonary toileting

Risk for impaired breathing pattern

Risk for trauma

Diagnosis:

Impaired physical mobility

Diagnosis

Disturbed sensory perception

Acute pain

ABC'S

Neurological Assessments

Assessments

Catheter maintenance

Assessments

Vital signs

Pulmonary artery pressure

Intake and output

Disorder education

Treatments

Test to be done

Rehab

Medication

Patient Teaching:

Patient Teaching

Stress management

S/S of complications

Pain management

IDT meetings

Assess independence

Family education

Patient support

Medication

Discharge Teaching:

Discharge

Teaching

Follow up appointments

Address goals and concerns

Home health arrangement