Page 171 - ATP-P 11th Ed

NEUROGENIC / SPINAL SHOCK PROTOCOL

SPECIAL CONSIDERATIONS SECTION 1
1. Neurogenic shock refers to the triad of hypotension, bradycardia, and peripheral
vasodilation resulting from severe autonomic dysfunction and the interruption of
sympathetic nervous system control in acute spinal cord injury. Hypothermia is
also characteristic.
2. Neurogenic shock should be considered a diagnosis of exclusion in the setting of
trauma.
3. Decreased vascular resistance with resultant warm extremities (depending on
surrounding air temperatures) as opposed to cool extremities with hemorrhagic/
hypovolemic shock.
4. Neurogenic shock typically occurs with spinal cord injuries at or above T6.
5. Neurogenic shock needs to be differentiated from hemorrhagic/hypovolemic
and spinal shock.
a Hemorrhagic/hypovolemic shock tends to be associated with tachycardia.
b. Spinal shock is defined as the complete loss of all neurologic function, in-
cluding reflexes and rectal tone, below a specific level that is associated with
autonomic dysfunction. It is a state of transient physiologic (rather than ana-
tomic) reflex depression of cord function below the level of injury with asso-
ciated loss of all sensorimotor functions. An initial increase in blood pressure
due to the release of catecholamines is noted, followed by hypotension. Flac-
cid paralysis, including of the bowel and bladder, is observed. Sometimes
sustained priapism develops. These symptoms tend to last several hours to
days until the reflex arcs below the injury level begin to function again.

Signs and Symptoms
1. Presents after spinal cord injury with either complete or incomplete paralysis
2. Hypotension
3. Bradycardia (as opposed to tachycardia with hypovolemic shock)
4. Priapism
5. Altered mental status
6. Oliguria
7. Loss of bowel/bladder control
8. Warm extremities below the point of injury (dependent on environmental air temperature)
9. Hypothermia

160 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 161