Chapter 25: Shock- Neurogenic Flashcards

1
Q

What is the definition?

A

Inadequate tissue perfusion from loss of sympathetic vasoconstrictive tone

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2
Q

What are the common causes?

A

Spinal cord injury:

  • Complete transection of spinal cord
  • Partial cord injury with spinal shock
  • Spinal anesthesia
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3
Q

What are the signs/symptoms?

A

Hypotension and bradycardia, neurologic deficit

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4
Q

Why are heart rate and BP decreased?

A

Loss of sympathetic tone (but hypovolemia [e.g., hemoperitoneum] must be ruled out)

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5
Q

What are the associated findings?

A

Neurologic deficits suggesting cord injury

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6
Q

What MUST be ruled out in any patient where neurogenic shock is suspected?

A

Hemorrhagic shock!

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7
Q

What is the treatment?

A

IV fluids (vasopressors reserved for hypotension refractory to fluid resuscitation)

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8
Q

What is spinal shock?

A

Complete flaccid paralysis immediately following spinal cord injury; may or may not be associated with circulatory shock

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9
Q

What is the lowest reflex available to the examiner?

A

Bulbocavernous reflex: checking for contraction of the anal sphincter upon compression of the glans penis or clitoris

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10
Q

What is the lowest level voluntary muscle?

A

External anal sphincter

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11
Q

What are the classic findings associated with neurogenic shock?

A
  • Hypotension
  • Bradycardia or lack of compensatory tachycardia
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12
Q

What is the acronym for treatment options for anaphylactic shock?

A

“BASE”:

  • Benadryl
  • Aminophylline
  • Steroids
  • Epinephrine
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13
Q

What is the treatment?

15-year-old s/p trampoline injury with tetraplegia (a.k.a.“quadriplegia”) with hypotension. No other injuries on CT scans

A

Neurogenic shock; treat with IV fluids and then vasopressors as needed

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