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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Monday, March 13, 2023

Neurogenic Shock

emDOCs - March 13, 2023 - By Kira Brayan; Jenny Beck-Esmay
Reviewed by: Jessica Pelletier, Marina Boushra, Alex Koyfman; Brit Long
Pearls and Pitfalls 
-Consider neurogenic shock in hypotensive trauma patients with high-level spinal injuries who present with signs of vasodilation but do not have compensatory tachycardia.
-Focal neurologic deficit is not a defining feature of neurogenic shock and neurogenic shock can be present in the setting of a normal neurologic exam. Physical exam of the thoracolumbar spine has poor sensitivity for spine and spinal canal injury. There should be a low threshold to obtain imaging in patients presenting with symptoms of neurogenic shock
-Neurogenic shock is a diagnosis of exclusion in trauma patients. Other causes of hypotension should be considered, particularly hemorrhagic shock in trauma patients, before coming to the diagnosis of neurogenic shock
–CT is the gold standard for bony spinal trauma, but MRI is necessary for suspected spinal cord injuries
-IV fluids are not adequate for hypotension caused by neurogenic shock and these patients will require vasopressors (norepinephrine is first line) to maintain adequate blood pressure.