Neurogenic shock is a distributive type of shock resulting in hypotension (low blood pressure), often with bradycardia (slowed heart rate), caused by
disruption of autonomic nervous system pathways
. It can occur after damage to the central nervous system, such as spinal cord injury and traumatic brain injury.
What usually accompanies neurogenic shock?
Neurogenic shock may be accompanied by
bradycardia
, for which atropine can be administered. Phenylephrine should be avoided, as it could result in significant reflex bradycardia. Dopamine and epinephrine may be favored due to their chronotropic effects.
What is the most common cause of neurogenic shock?
The cause of neurogenic shock is usually
a spinal cord injury
. When the nerves in the spinal cord are damaged, they stop sending messages to the nerves that control other functions in the body. If nerve signals to the muscles in the blood vessels are shut down, the vessels stop working properly.
What are signs of neurogenic shock?
- dizziness.
- nausea.
- vomiting.
- blank stares.
- fainting.
- increased sweating.
- anxiety.
- pale skin.
Which of the following parameters would you expect for a patient with neurogenic shock?
Patients in neurogenic shock usually present with a
systolic blood pressure of approximately 70 mm Hg or lower and a pulse below 60
.
What is neurogenic shock?
Neurogenic shock is
a combination of both primary and secondary injuries that lead to loss of sympathetic tone and thus unopposed parasympathetic response driven by the vagus nerve
. Consequently, patients suffer from instability in blood pressure, heart rate, and temperature regulation.
What vasopressor is used for neurogenic shock?
Norepinephrine
is commonly used in neurogenic shock, severe cardiogenic shock, and obstructive shock due to pulmonary embolism. Norepinephrine should be used with caution in patients who are taking MAO inhibitors and tricyclic antidepressants, as this may cause significant hypertension due to reduced metabolism.
What are the complications associated with neurogenic shock?
Common complications include
autonomic dysreflexia, orthostatic hypotension, reduced cardiovascular reflexes and absence of cardiac pain during ischemia
[18]. Independent of neurogenic shock, autonomic dysreflexia (AD) is a potentially fatal complication that occurs in 48–90% of patients with injuries above T6 [17].
What are the initial interventions needed for a patient in neurogenic shock?
Once occult sources of hemorrhage have been excluded, initial treatment of neurogenic shock focuses on fluid resuscitation.
Judicious fluid replacement with isotonic crystalloid solution to a maximum of 2 L
is the initial treatment of choice.
What is the most common type of shock?
Septic shock, a form of distributive shock
, is the most common form of shock among patients admitted to the intensive care unit, followed by cardiogenic and hypovolemic shock; obstructive shock is rare [1,2].
What physical assessment findings would you expect to find to confirm neurogenic shock?
Assessing patients for neurogenic shock
On physical assessment, you may detect
bradycardia
; hypotension; poikilothermy, hypothermia, or both, causing a flushed appearance; warm, dry skin (from vasodilation); and flaccid paralysis below the spinal injury level.
What type of shock is anaphylaxis?
Anaphylactic shock:
a form of distributive shock without inhibition
of oxygen consumption.
What is the difference between hypovolemic shock and neurogenic shock?
Hypovolemic shock is treated with fluids
(saline) in minor cases
, and blood transfusions in severe cases. Neurogenic shock is the most difficult to treat as spinal cord damage is often irreversible. Immobilization, anti-inflammatories such as steroids and surgery are the main treatments.
Which of the following vital signs is most consistent with an adolescent neurogenic shock after a spinal cord injury?
Children with neurogenic shock usually present with
hypotension and bradycardia
because of the loss of sympathetic tone.
How do Emts treat neurogenic shock?
The providers identify that the patient is experiencing neurogenic shock, which can result from severe damage to the central nervous system (brain and spinal cord), and opt to
administer an infusion of dopamine
, a medication used to constrict blood vessels for blood pressure support.
Can you have neurogenic shock and autonomic dysreflexia?
Neurogenic shock can persist for 1-6 weeks after the injury
[3, 5, 24]. Autonomic dysreflexia, low resting blood pressure, and orthostatic hypotension are not uncommon during the chronic phase, often after neurogenic shock has resolved [1, 2, 34, 35].
Why is neurogenic shock different?
Symptoms of neurogenic shock are differentiated from other forms
of shock by the lack of signs of the compensatory mechanisms triggered by the SNS
, usual in other forms of shock.
What are examples of vasopressors?
- Norepinephrine.
- Epinephrine.
- Vasopressin (Vasostrict)
- Dopamine.
- Phenylephrine.
- Dobutamine.
How does neurogenic shock resolve?
Therefore, treatment for neurogenic shock focuses on restoring heart rate and blood pressure to normal levels. Treatment for neurogenic shock generally involves: IV Fluids. IV fluids are the primary treatment for low blood pressure.
What are the 4 stages of shock?
The shock syndrome is a pathway involving a variety of pathologic processes that may be categorized as four stages:
initial, compensatory, progressive, and refractory
(Urden, Stacy, & Lough, 2014).
What is the role of neurogenic shock in the pathophysiology of spinal cord injury SCI )?
Neurogenic shock refers to
the hemodynamic triad of hypotension, bradycardia, and peripheral vasodilation resulting from severe autonomic dysfunction and the interruption of sympathetic nervous system control
in acute spinal cord injury.
How is neurogenic shock different?
Spinal shock occurs in phases (I–IV) that are temporally distributed over a period of weeks to months, whereas neurogenic shock tends to
have sudden onset that requires more urgent management
.
What should you do for a patient whose shock is caused by vasodilation due to a spinal cord injury?
In the case of isolated neurogenic shock, the resultant vasodilation results in pooling of blood and decreased venous return to the heart. Initial treatment for this is
IV fluid
, but if there’s no response, pressors can be considered.
Which type of shock is most likely to happen as a result of being in the hospital?
Septic shock
is the most common form of distributive shock and is characterized by considerable mortality (treated, around 30%; untreated, probably >80%). In the United States, this is the leading cause of noncardiac death in intensive care units (ICUs).
How can you prevent neurogenic shock?
There is no way to prevent neurogenic shock from occurring other than to avoid any severe injuries that may cause damage to the nervous system. Falls, accidents, and other traumas can be difficult to prevent, however.
Use safety precautions whenever possible
.
What do all types of shock have in common?
While the general signs for all types of shock are
low blood pressure, decreased urine output, and confusion
, these may not always be present. Specific subtypes of shock may have additional symptoms.
How do you distinguish between cardiogenic and hypovolemic shock?
Cardiogenic shock is caused by inadequate contractility of the heart. One of the key differences between hypovolemic and cardiogenic shock is
the work of breathing
. In both cases, there will be tachypnea, but in hypovolemic shock the effort of breathing is only mildly increased.
Which manifestation is associated with cardiogenic shock?
Cardiogenic shock signs and symptoms include:
Rapid breathing
.
Severe shortness of breath
.
Sudden, rapid heartbeat (tachycardia)
What are the 3 stages of shock?
- Restlessness, agitation and anxiety – the earliest signs of hypoxia.
- Pallor and clammy skin – this occurs because of microcirculation.
- Nausea and vomiting – decrease in blood flow to the GI system.
- Thirst.
- Delayed capillary refill.
- Anxiety or agitation.
- Cool, clammy skin.
- Confusion.
- Decreased or no urine output.
- Generalized weakness.
- Pale skin color (pallor)
- Rapid breathing.
- Sweating, moist skin.
What are the 4 major causes of shock?
Shock may result from
trauma, heatstroke, blood loss, an allergic reaction, severe infection, poisoning, severe burns or other causes
. When a person is in shock, his or her organs aren’t getting enough blood or oxygen. If untreated, this can lead to permanent organ damage or even death.
What are three nursing diagnosis for a patient diagnosis of neurogenic shock?
Based on the assessment data, the nursing diagnoses for a patient with neurogenic shock are: Risk for impaired breathing pattern related to impairment of innervation of diaphragm (lesions at or above C-5).
Risk for trauma related to temporary weakness/instability of spinal column.
What is Brown Séquard syndrome?
Brown-Séquard syndrome is
a rare spinal disorder that results from an injury to one side of the spinal cord in which the spinal cord is damaged but is not severed completely
. It is usually caused by an injury to the spine in the region of the neck or back.
Is anaphylactic shock neurogenic?
Hypovolemic shock (caused by too little blood volume) Anaphylactic shock (
caused by allergic reaction
) Septic shock (due to infections) Neurogenic shock (caused by damage to the nervous system)
What are the 4 types of allergic reactions?
Four different types of allergic reactions are
immediate, cytotoxic, immune-complex mediated and delayed hypersensitivity reactions
. Allergic reactions occur when the body’s immune system has a reaction to a substance it sees as harmful, called an allergen.
What are the 5 most common triggers for anaphylaxis?
- foods – including nuts, milk, fish, shellfish, eggs and some fruits.
- medicines – including some antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin.
- insect stings – particularly wasp and bee stings.
- general anaesthetic.
What are some pharmaceuticals for a patient with neurogenic shock?
- norepinephrine.
- epinephrine.
- dopamine.
- vasopressin.
Why is someone with neurogenic shock hypotensive and Bradycardic?
Neurogenic shock is a type of distributive shock, consisting of the hemodynamic triad of hypotension, bradycardia, and peripheral vasodilatation, attributed to severe central nervous system damage (head trauma, cervical cord trauma, or high thoracic cord injuries), resulting
in loss of sympathetic stimulation to the
…
What is the clinical hallmark of neurogenic shock?
The hallmarks of neurogenic shock are
hypotension with either bradycardia or a normal heart rate despite fluid replenishment
. If the hypotension cannot be corrected with fluid expansion, vasopressor therapy may be required.
