Neurogenic shock is defined as a loss of sympathetic stimulation, resulting in parasympathetic stimulation. The body experiences a massive vasodilation and the body is unable to compensate for the drop in cardiac output.
What causes Neurogenic Shock?
- Brain Injury
- Spinal Cord injury (cervical injury or high thoracic spinal injury)
- Spinal Anesthesia
Neurogenic Shock Assessment
Sympathetic nervous system loss means the body loses the “fight or flight” response and the parasympathetic nervous system’s “rest and digest” system is unopposed.
- Bradycardia instead of tachycardia
- Bradypnea rather than tachypnea
- Hypotension
- Skin warm, dry, and flushed
- Full pulses
- Priapism
Neurogenic Shock Interventions
- Airway, Breathing, and Circulation to prevent secondary cord injury
- Fluid resuscitation
- Mean Arterial Pressure (MAP) above 60-70 mmHg
- Central Venous Pressure (CVP) 8-12 mmHg
- Urine output 0.5mL/kg per hour or 30-60 mL per hour
- Normal serum lactate levels
- SvO2 65-75%
- Systolic Blood Pressure above 90 mmHg
- Administer vasopressors (phenylephrine)
- Administer atropine for bradycardia
- Routine administration of high-dose corticosteroids no longer recommended
What is Obstructive Shock?
Obstructive shock is defined as inadequate cardiac output and tissue perfusion due to resistance to ventricular filling.
What causes Obstructive Shock
- Pulmonary embolism
- Pericardial tamponade
- Tension pneumothorax
Obstructive Shock Interventions
- Determine the cause of hypovolemia and fix the problem
- Pulmonary Embolism
- Intravenous anticoagulation and thrombolytics
- Pericardial tamponade
- Immediate pericardiocentesis and subsequent surgical repair
- Tension pneumothorax
- Immediate needle thoracotomy and chest tube placement
Introduction to ATI TEAS Testing 2018
