Neurogenic shock

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Neurogenic shock is shock caused by the sudden loss of the autonomic nervous system signals to the smooth muscle in vessel walls. This can result from severe central nervous system (brain and spinal cord) damage. With the sudden loss of background sympathetic stimulation, the vessels suddenly relax resulting in a sudden decrease in peripheral vascular resistance (vasodilatation) and decreased blood pressure.

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Nội dung Text: Neurogenic shock

Neurogenic shock I>Definition: Neurogenic shock is shock caused by the sudden loss of the autonomic nervous system signals to the smooth muscle in vessel walls. This can result from severe central nervous system (brain and spinal cord) damage. With the sudden loss of background sympathetic stimulation, the vessels suddenly relax resulting in a sudden decrease in peripheral vascular resistance (vasodilatation) and decreased blood pressure. Simple fainting (syncope) is a variation of neurogenic shock. It o ften is the result of a temporary gravitational pooling of the blood as a person stands up. As the person falls, blood again rushes to the head, and the problem is solved. Neurogenic shock may also be induced by fear or horror, which will override the auto nomic nervous system control.
Shell shock and bomb shock are other variations of neurogenic shock. These are psychological adjustment reactions to extremely stressful wartime experiences and do not relate to the collapse of the cardiovascular system. Sympt oms range from intense fear to complete dementia and are manifestations of a loss of nervous control. II>signs and symtoms -hypotension -bradycardia -warm, dry extremities -peripheral vasodilation venous pooling -Poikilothermia - Priapism due to PNS stimulation -decreased cardiac output (with cervical or high thoracic injury)
III>Diagnosis and differential The diagnosis of neurogenic shock should be one of exclusion. Neurogenic shock must be differentiated from other types of shock, particularly hypovolemic. When dealing with a trauma patient, one must always assume that any hypotension is a result of ongoing blood loss. A patient suffering from neurogenic shock may also have concomitant injuries which may contribute to hemodynamic instability. Clinical clues such as hypotension, bradycardia, neurologic dysfunction, and warm, dry skin may lead the clinician to suspect neurogenic shock; however, only after other injuries have been identified and treated can the diagnosis of neurogenic shock safely be made.