Neurogenic shock - Revision history

Elcatracho: /* Diagnosis */

2021-02-11T00:26:47Z

Diagnosis

← Older revision		Revision as of 00:26, 11 February 2021
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	===Diagnosis===		===Diagnosis===
			*Diagnosis of exclusion after ruling out other causes of hypotension (principally hemorrhagic shock in the setting of trauma)

	==Management==		==Management==

Elcatracho: /* Workup */

2021-02-11T00:26:10Z

Workup

← Older revision		Revision as of 00:26, 11 February 2021
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	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
			*Standard [[trauma\|ATLS]] workup

	===Diagnosis===		===Diagnosis===

Rossdonaldson1: /* See Also */

2020-10-27T20:06:06Z

Rossdonaldson1: /* See Also */

2020-10-27T20:05:40Z

Rossdonaldson1: /* Additional Considerations */

2020-10-27T20:05:06Z

Additional Considerations

← Older revision		Revision as of 20:05, 27 October 2020
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	===Additional Considerations===		===Additional Considerations===
	*Prevent hypothermia - consider temperature probe Foley		*Prevent [[hypothermia]] - consider temperature probe Foley
	*High risk of [[VTE]] in paraparesis or tetraparesis		*High risk of [[VTE]] in paraparesis or tetraparesis
	**Up to 40% in non-prophylaxed		**Up to 40% in non-prophylaxed

Rossdonaldson1: /* Background */

2020-10-27T20:04:40Z

Background

← Older revision		Revision as of 20:04, 27 October 2020
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	**T1-L3: Partial sympathetic denervation		**T1-L3: Partial sympathetic denervation
	**Below L4: no sympathetic denervation		**Below L4: no sympathetic denervation
	*Lasts 1-3 wk		*Lasts 1-3 week

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Background */

2020-10-27T20:04:29Z

Background

← Older revision		Revision as of 20:04, 27 October 2020
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	==Background==		==Background==
	*Do not confuse with [[~~Spinal Shock~~]]		*Do not confuse with [[spinal shock]]
	*Diagnosis of exclusion		*Diagnosis of exclusion
	**Never presume hypotension in trauma patient is due to neurogenic shock		**Never presume hypotension in trauma patient is due to neurogenic shock

Rossdonaldson1: /* Additional Considerations */

2020-10-27T20:03:05Z

Additional Considerations

← Older revision		Revision as of 20:03, 27 October 2020
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	**Up to 40% in non-prophylaxed		**Up to 40% in non-prophylaxed
	**Must weigh benefits of VTE prophylaxis and risk of bleed from LMWH		**Must weigh benefits of VTE prophylaxis and risk of bleed from LMWH
	**Low dose SC heparin at 500 units q8hrs plus SCDs may be alternative		**Low dose SC [[heparin]] at 500 units q8hrs plus SCDs may be alternative

	==See Also==		==See Also==

Rossdonaldson1: /* Additional Considerations */

2020-10-27T20:02:52Z

Additional Considerations

← Older revision		Revision as of 20:02, 27 October 2020
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	===Additional Considerations===		===Additional Considerations===
			*Prevent hypothermia - consider temperature probe Foley
	*High risk of [[VTE]] in paraparesis or tetraparesis		*High risk of [[VTE]] in paraparesis or tetraparesis
	**Up to 40% in non-prophylaxed		**Up to 40% in non-prophylaxed
	**Must weigh benefits of VTE prophylaxis and risk of bleed from LMWH		**Must weigh benefits of VTE prophylaxis and risk of bleed from LMWH
	**Low dose SC heparin at 500 units q8hrs plus SCDs may be alternative		**Low dose SC heparin at 500 units q8hrs plus SCDs may be alternative

	~~#Supplemental [[O2]] to perfuse injured spinal cord~~
	~~#Mechanical ventilation and oxygenation if spinal perfusion is compromised~~
	##Manual in-line stabilization reduces cervical movement better than C-collar, but be careful of tracheal pressures inadvertently applied which can worsen laryngeal visualization<ref>The effect of laryngoscopy of different cervical spine immobilisation techniques. Heath KJ. Anaesthesia. 1994 Oct; 49(10):843-5.</ref><ref>Manual in-line stabilization increases pressures applied by the laryngoscope blade during direct laryngoscopy and orotracheal intubation. Santoni BG, Hindman BJ, Puttlitz CM, Weeks JB, Johnson N, Maktabi MA, Todd MM. Anesthesiology. 2009 Jan; 110(1):24-31.</ref>
	~~##Direct laryngoscopy causes C-spine extension at atlanto-occipital junction, C1-C2, and C4-C7 in order from most to least~~
	##Consider video laryngoscopy with hyperangulated stylet or bougie assisted DL to intubate higher-grade laryngoscopy views of vocal cords without C-spine overextension<ref>Cervical spinal motion during intubation: efficacy of stabilization maneuvers in the setting of complete segmental instability. Lennarson PJ, Smith DW, Sawin PD, Todd MM, Sato Y, Traynelis VC. J Neurosurg. 2001 Apr; 94(2 Suppl):265-70.</ref>
	~~##Post-intubation sedation takes into consideration hemodynamics and potential intraoperative EMG and evoked potential monitoring by anesthesia~~
	~~##*[[Opioids]] do not impact evoked potential monitoring~~
	##*[[Ketamine]] may enhance evoked potential monitoring<ref>Improvement of motor-evoked potentials by ketamine and spatial facilitation during spinal surgery in a young child. Erb TO, Ryhult SE, Duitmann E, Hasler C, Luetschg J, Frei FJ. Anesth Analg. 2005 Jun; 100(6):1634-6.</ref>
	##*Consider [[dexmedetomidine]] as a [[Propofol]] sparing medication in TIVA<ref>Effects of dexmedetomidine on intraoperative motor and somatosensory evoked potential monitoring during spinal surgery in adolescents. Tobias JD, Goble TJ, Bates G, Anderson JT, Hoernschemeyer DG. Paediatr Anaesth. 2008 Nov; 18(11):1082-8.</ref>
	~~#Prevent hypothermia - consider temperature probe Foley~~

	==See Also==		==See Also==

Rossdonaldson1: /* Neurogenic Shock Management */

2020-10-27T20:01:41Z

Neurogenic Shock Management

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	==Management==		==Management==
	===Neurogenic Shock Management===		===Neurogenic Shock Management===
	''Exclude other causes of shock''		''Exclude other causes of shock!''
	*Judicious [[IVF]] with normal saline, with UOP >30 cc/hr		*Judicious [[IVF]] with normal saline, with UOP >30 cc/hr
	**Hypotonic fluids such as D5W and 0.45% NS '''are contraindicated'''		**Hypotonic fluids such as D5W and 0.45% NS '''are contraindicated'''

← Older revision		Revision as of 20:06, 27 October 2020
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	==See Also==		==See Also==
	*[[Spinal cord injury]]		*[[Spinal cord injury]]
	*[[Spinal ~~Cord Compression~~ (~~Non~~-~~Traumatic~~)]]		*[[Spinal cord compression (non-traumatic)]]
	*[[Autonomic ~~Dysreflexia~~]]		*[[Autonomic dysreflexia]]
	*[[Spinal ~~Shock~~]]		*[[Spinal shock]]

	==External Links==		==External Links==

← Older revision		Revision as of 20:05, 27 October 2020
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	==See Also==		==See Also==
	*[[Spinal ~~Cord Trauma~~]]		*[[Spinal cord injury]]
	*[[Spinal Cord Compression (Non-Traumatic)]]		*[[Spinal Cord Compression (Non-Traumatic)]]
	*[[Autonomic Dysreflexia]]		*[[Autonomic Dysreflexia]]