Treatment of neurogenic shock

Circulatory Insufficiency

1. Differentiate Hypovolaemic from Neurogenic Shock In cervical and thoracic spinal cord injuries, Neurogenic shock with bradycardia and hypotension are common.
   In Neurogenic Shock, unlike Hypovolaemic Shock, the pulse rate is slow and of good amplitude and the skin is usually warm and dry except if the patient has been exposed to a cold environment (see 5). Tachycardia and clammy skin are seen in hypovolaemia.
   Neurogenic and Hypovolaemic shock may coexist.
   When this happens, Neurogenic shock exacerbates the effects of Hypovolaemic shock by disabling the vasoconstrictive reflexes that ordinarily preserve blood flow to vital organs.

Spinal shock
Spinal shock is a state of transient physiological (rather than anatomical) reflex depression of cord function below the level of injury with associated loss of all sensorimotor functions. An initial increase in blood pressure is noted due to the release of catecholamines, followed by hypotension. Flaccid paralysis, including of the bowel and bladder, is observed, and sometimes sustained priapism develops. These symptoms tend to last several hours to days until the reflex arcs below the level of the injury begin to function again (eg, bulbocavernosus reflex, muscle stretch reflex [MSR]).
Neurogenic shock
Neurogenic shock is manifested by the triad of hypotension, bradycardia, and hypothermia. Shock tends to occur more commonly in injuries above T6, secondary to the disruption of the sympathetic outflow from T1-L2 and to unopposed vagal tone, leading to decrease in vascular resistance with associated vascular dilatation. Neurogenic shock needs to be differentiated from spinal and hypovolemic shock. Hypovolemic shock tends to be associated with tachycardia.