(PALS Review) Neurogenic Shock
Neurogenic Shock Overview:
Neurogenic Shock is a type of distributive shock in which severe central nervous system trauma (i.e. spinal cord injury) causes a rapid loss in sympathetic stimulation.
This loss of sympathetic tone results in massive vasodilation and a decrease in peripheral vascular resistance causing blood to pool in the venous system. This maldistribution leads to sudden and profound hypotension.
Because of the neurologic injury and loss of sympathetic stimulation, compensatory mechanisms that normally activate the release of epinephrine and norepinephrine do not function properly. The effect of the loss of sympathetic tone is life threatening, and early recognition and management is of utmost importance.
Signs & Symptoms:
Children with neurogenic shock usually present with hypotension and bradycardia because of the loss of sympathetic tone. The following are signs and symptoms of neurogenic shock:
- rapid onset of hypotension from massive vasodilation
- possible bradycardia. No tachycardia present because of the loss of sympathetic tone
- hypotension with a wide pulse pressure
- warm, flushed skin
- priapism r/t vasodilation
Management of Neurogenic Shock:
Unlike most forms of shock, the state of neurogenic shock is unlikely to be corrected or improved with fluid resuscitation.
The primary management for neurogenic shock involves the administration of vasopressors that will increase peripheral vascular resistance, and inotropic agents that will increase heart rate.
These changes will result in a more evenly distribute blood volume within the circulatory system. Common medications used are dopamine (inotropic), vasopressin, norepinephrine , and atropine.