Thứ Hai, 13 tháng 1, 2014

Neurogenic Shock

Neurogenic Shock Neurogenic shock occurs after serious injury to the nervous system and/or spinal cord. This is a potential complication and can cause organ dysfunction or even death. Often neurogenic shock occurs after acute spinal cord injury in 80-90% of cases. Cervix is the worst affected area because of this shock and sometimes the thoracic and lumbar region are also affected. Unlike spinal shock which occurs due to temporary spinal reflex action this shock is permanent. The major consequences of this shock are hypotension and bradycardia. It causes loss of autonomic tone and any disruption of sympathetic path would result in vagal tone leading to vasodilation.


A person having neurogenic shock is at increased risk of spinal cord ischemia. Many hemodynamic changes take place within the system due to shock leading to reversible reduction of sensory and motor functions of spinal cord.


Types of Shock :


Any type of shock can damage multiple organs of your body. Shock occurs when the body lacks enough blood flow. Cardiogenic shock occurs due to heart problems, anaphylactic shock occurs due to allergic reaction and hypovolemic shock happens due to black of blood quantity and septic shock occurs due to infections and neurogenic shock occurs due to nervous system damage or spinal cord injury.


Causes :


Neurogenic shock occurs when there is severe injury to the spinal cord or central nervous system. The trauma or injury results in loss of sympathetic nerve stimulation of blood vessels which would return back to relaxed position (vasodilation) causing sudden decrease in blood pressure. This sudden low blood pressure leads to neurogenic shock causing risk to brain and spinal cord. This type of shock needs prompt medical treatment failing which the consequences can be fatal.


The person affected with neurogenic shock cannot have normal functions of dilation and contraction of blood vessels. It would impair the normal blood circulation causing hypothermia due to poor circulation of blood. Some people develop bradycardia which is reduction of heartbeat rate.


Symptoms :


Some of the signs of neurogenic shock are sudden low blood pressure, lack of oxygen to the tissues, cardiac arrest (for some people), increased heartbeat, dull eyes, shallow breathing, weakness, feeling unconscious, anxiety, restlessness, hypothermia, dryness in the mouth and confusion.


Diagnoses :


The doctor will look for vital signs of the patient by measuring his blood pressure and monitoring his heartbeat. Special catheters would be inserted into the veins of neck and chest for measuring the right pressure in the heart. Tubes are inserted in the bladder for measuring urine output. Blood test and radiologic tests are administered after giving the patient first-aid.


Treatment :


After examining the patient with neurogenic shock the doctor will put him on intravenous fluids. Hypotension caused cannot be due to neurogenic shock only since it can be due to hemorrhage (loss of blood). Patients who have met with accidents will be on heavy blood loss leading to hemorrhagic shock. Such patients will be treated with crystalloid or colloid fluids to prevent continuous blood loss. Then he should be resuscitated followed by spinal cord decompression.


The fluid level should be regularized first by utilizing pressor agents. Dopamine is injected along with inotropoic agents. For major trauma certain types of vasopressors are given in the form of first line treatment. Hypotension should be treated promptly to avoid ischemic arrest. Next he will be given supplementary oxygen depending on his health condition and examining his vital signs. In the emergency unit, diagnoses and treatment will be done simultaneously.


For severe blood loss, blood transfusion is done. If bleeding is not the cause for shock, IV fluids are started to normalize the volume of fluids in the blood vessels. Careful examination and evaluation of the brain and vertebral column is necessary for locating the injury of spine.


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