SHADES OF SHOCK 3

4.3 Neurogenic shock due to decreased peripheral resistance
resulting from:
I) Increase vagal tone as in case of severe pain,
intense emotion, can lead to slow heart rate.
ii) Spinal anesthesia leading to loss of sympathetic impulse
And enlarged blood vessels-leads to pooling of blood


Neurogenic shock, can occur in severe injury to the spinal cord/
head injury-results in failure of the sympathetic nervous
system resulting in insufficient vascular tone.
The vasodilatation and increased venous capacity results in less
cardiac filling (3.1) and poor vascular resistance-less tissue perfusion and shock .

Neurogenic Shock
Hypotension and bradycardia may occur following acute cervical or high thoracic spinal cord injury.
-This result from blockage of sympathetic outflow in presence of unopposed vagal tone result in clinical features referred to as neurogenic shock,
-The diagnosis should be suspected in any patient with hypotension and bradycardia following injury.
-In some cases, these findings may represent the first suggestion of a spinal cord injury in a comatose patient.
-The patient with neurogenic shock is typically warm and well perfused.
-If a pulmonary artery catheter is in situ, the cardiac index may be elevated while the systemic vascular resistance is markedly reduced.
-Occult hemorrhage should be ruled out before attributing spinal cord injury as the exclusive cause of hypotension.
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