Neurogenic shock

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Overview

Neurogenic shock is shock caused by the sudden loss of the sympathetic 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 and decreased blood pressure.

Etiology

1. Spinal Cord Injury/Ischemia
2. Regional Anesthesia
3. Drugs
4. Neurological Disorders

Signs and symptoms

• Hypotension
• Bradycardia
• Warm, dry extremities
• Peripheral vasodilation
• Venous pooling
• Poikilothermia
• Priapism Due to PNS stimulation
• Decreased cardiac output (with cervical or high thoracic injury)

Treatment of Neurogenic shock

• Large volumes of fluid may be needed to restore normal hemodynamics
• Vasopressors (Norepinephrine)
• Atropine (this vagolytic reduces vagal tone, increases heart rate and increases cardiac output)