What is neurogenic shock?

Neurogenic shock is defined as a traumatic spinalinjury, where a sudden loss of autonomic tone occurs due to injury causedat the level of the spinal cord.

There is adecrease in sympathetic control of muscle tone, as a result of acute spinal cord injury and among its consequences is hypotension and bradycardia.

Important: A differential diagnosis is necessary sinceCardiogenicShock andSeptic Shockpresent the same symptoms.

In this context, when this shock occursthere is a failure in communication between the brain and the organism, making it difficult for blood to circulate through the body.

Neurogenic shockis a life-threatening condition, due to the lack of blood flow, limiting the supply of oxygen to the cells of the organs, and irreversible damage can occur in them.

It should not be confused with Hypovolemic Shockwhere significant blood loss occurs, a drop in blood pressure and bradycardia also occurs. (1)

Note: The area most affected by neurogenic shock is the cervical region of the spine. Neurogenic shock is also considered a Distributive Shock. (2)

What are the causes of neurogenic shock?

Below we describe the most frequent causes for which this type of shock occurs:

1. Spinal injury

Spinal cord injuries are one of the main reasonsWhy neurogenic shock occurs.

These are characterized by a trauma caused by an external physical force, causing damage to the vertebrae, ligaments or discs of the spine with incidence on the spinal cord, affecting the nervous system.

Important: Spinal cord injuries do not always lead to neurogenic shock.

In cases of sudden spinal trauma, Primary Care should focus on Immobilization to prevent irreversible damage to the spinal cord. (3)

Note: Traffic accident injuries, for example, can cause spinal trauma with spinal cord involvement.

2. Epidural anesthesia

Accidents in the application of epidural anesthesia are very rare and occur when the needle pierces the dura mater and injures the spinal cord.

First , weakness in the lower extremities occurs, from the fourth day associated with other symptoms and then paraplegia 24 hours after the weakness of the extremities. (4)

3. Drugs

The inappropriate use of some medications, which affect the central nervous system and also the incorrect application of anesthetics in terms of location and/or concentration or due to their neurotoxicity, can lead to neurogenic shock.

What are the symptoms of neurogenic shock?

This condition has very specific symptoms in patients with neurogenic shock, which we describe below:

1. Low blood pressure

One of the characteristic symptoms of this type of shock in patients is hypotension. This occurs due to vasodilation of the blood vessels , preventing adequate blood flow from the heart.

In this sense, the measurement of the systolic pressure in the patient is below 100 mmHg or a 20% decrease in systolic pressure.

Note: Hypotension can occur more frequently in pregnant patients, since physiologically their state of pregnancy keeps them hypotensive.

The treatment will be aimed at correcting the hypotension in the patient, through the administration of liquids, with a previous reading of the vital signs.

2. Fast breathing and pulse

Patients with neurogenic shock may also present with altered states of respiration and increased heart rate.

When states of hypotension occur , the heart rate tends to increase because the body activates the mechanisms to restore body temperature, increasing blood flow to the organs.

On the other hand, hyperventilation in shock occurs because the patient enters a state of anxiety and agitation and consequently the respiratory rate increases.

The treatment for states of hyperventilation is the administration of oxygen to ensure adequate ventilation.

Note: It is important to review vital signs to establish intervention strategies.

3. Cold and pale skin

As we have been commenting, in shock states the volume and blood flow to the organs decrease, including the skin.

The patient in these conditions loses body temperature and the skin becomes pale due to the decrease in blood in the capillaries.

To highlight:The treatment with liquids to restore blood pressure, may help regulate body temperature as well as blood flow to the capillaries. This aids perfusion, preventing secondary spinal cord injury.

4. Dizziness or fainting

Due toinsufficient blood supplyto the organs, the brain is also affected, receiving less oxygen for its functions. This insufficiency of oxygen causes weakness, sweating and nausea, causing loss of consciousness.

Note: Treatment for this condition is the supply of fluids with the administration of oxygen, intended to correct hypotension and oxygen insufficiency in the brain.

5. Confusion and agitation

These states of shock in the patient Generate a feeling of insecurity for fear of death, and the consequent appearance of a state of anxiety, generating despair and shock.

Placing the patient in a state of tranquility is one of the goals of intervention treatment in neurogenic shock, helping to restore their emotional state.

How is the treatment for neurogenic shock?

One of the first actions to be taken is to immediately contact the local emergency number or, failing that, take it to the nearest hospital.

This in order to give specialized medical attention immediately , to avoid secondary damage to the spinal cord and even death.

Important: The treatment for neurogenic shock will be carried out depending on the state in which it is found, the injuries it presents and the general condition of the patient, so evaluation by an emergency doctor is valuable.

In general, treatment will be directed at fluid resuscitation , including blood products if necessary, correction of the underlying disease, and sometimes vasopressor medications. (5)

Key Conclusions

  • Neurogenic shock occurs from one or more injuries to the spinal cord that cause a disruption of communication between the brain and the body.
  • Among the symptoms that can identify the presence of neurogenic shock are hypotension and bradycardia.
  • is vital
  • A differential diagnosis should be made to rule out other types of shock.
  • Immediate attention should be aimed at restoring blood pressure and lack of oxygen in the body.

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