SPINE - NON TRAUMA + TRAUMA
SHOCK - NEUROGENIC vs SPINAL
PromptCompare clinical features of neurogenic vs spinal shock
ResponseSpinal shock = neurological injury to spinal cord / initial period of cord ‘confusion’ that may overestimate degree of permanent neurological injury. Think Arreflexia, Flaccid paralysis
Neurogenic shock = distributive shock due to lack of sympathetic tone. Think Bradycardia / Hypotension / Warm skin / Poikilothermia (which is usually hypothermia in a hospital bed)
Neurogenic shock = distributive shock due to lack of sympathetic tone. Think Bradycardia / Hypotension / Warm skin / Poikilothermia (which is usually hypothermia in a hospital bed)
PromptManagement of Neurogenic Shock
ResponseMaintain MAP 85-90 with IV Fluid Hartmanns 1-2 L then noradrenaline infusion
Respiratory support as needed, especially if high C spinal cord injury
Early escalation of surgical decompression of spinal canal within 8 hours of injury (Can also include the definitive surgical management of other traumatic injuries)
Full spinal precautions when managing patient with 30 degrees head up
Other supportive measures
Thermal protection
Nasogastric tube
Urinary catheter
Rule out other causes of shock such as hypovolaemia
Supportive care: Immobilisation of injury / Analgesia / Antiemetics
Respiratory support as needed, especially if high C spinal cord injury
Early escalation of surgical decompression of spinal canal within 8 hours of injury (Can also include the definitive surgical management of other traumatic injuries)
Full spinal precautions when managing patient with 30 degrees head up
Other supportive measures
Thermal protection
Nasogastric tube
Urinary catheter
Rule out other causes of shock such as hypovolaemia
Supportive care: Immobilisation of injury / Analgesia / Antiemetics