Surgery
Shock
Neurogenic Shock
-
Injury to spinal cord (cervical, thoracic) high spinal anaesthesia.
-
Disruption of sympathetic efferent.
-
Loss of sweat gland innervation- anhydrosis.
-
Loss of vasomotor tone-
- profound vasodilatation,
- fall in peripheral vascular resistance.
-
loss of cardiac stimulation (T1-4).
-
Hypotension, bradycardia, dry & warm periphery
VASOVAGAL/ VASOGENIC SHOCK ( Part of neurogenic shock )
Pooling of blood due to dilatation of peripheral vascular system particularly in the limb muscles & in splanchnic bed
→ ↓Venous return to the heart leading to
→ low cardiac output & bradycardia
→ Blood flow to brain is reduced causing cerebral hypoxia & unconsciousness.
Management: Trendelenberg position— increases cerebral flow & consciousness is restored
Truama
Neurogenic shock
- Loss of sympathetic tone due to cord injury
- Hypotension, warm well perfused limbs, diminished/absent motor function
- Bradycardia
- Management:
- IV fluids, - vasopressors (Norepinephrine, epinephrine, phenylephrine, dopamine, and vasopressin) - corticosteroids