CMC COMPENDIUM
  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction

Spinal Shock and Neurogenic Shock - Dr. Asimos

11/21/2013

0 Comments

 
Picture
HIGH YIELD CONCEPTS:
  • “Neurogenic Shock” (Neurogenic Hypotension) refers to a loss of BP regulation (hypotension and bradycardia) following a complete SCI above the T5 level and is due to loss of sympathetic outflow to the systemic vasculature and heart.
  • “Spinal shock” is a neurologic phenomenon that generally lasts < 24 hours in the acute phase of a SCI and is best described as a transient physiologic reflex depression of cord function below the level of injury, resulting in loss of all sensorimotor functions.
  • A Central Cord Syndrome is the most common incomplete SC lesion, usually resulting from forced hyperextension in the setting of cervical spine DJD or spinal stenosis, and classically manifests as paresis mostly in the distal upper extremities with dysesthesias in a “cape-like” distribution.
Basics
  • Spine - 2 column concept; flexion - crush the front open the back, extension, crush the back and open the front; axial load - Jefferson fracture = unstable; rotational injuries - unilateral facet is stable; bilateral facet injury is unstable; Distraction injury - can cause hangmans fracture

  • Things to be aware of that can lead to spinal cord injury - Fracture, joint dislocation, ligamentous tearing, disc protrusion

  • Neurogenic shock = functional sympathectomy - high cord injury - lose sympathetic innervation. Also have parasympathetics unopposed - results in bradycardia and hypotension; look at the bladder as well because urination is a parasympathetically innervated - spinal cord injury = brisk bladder reflex.
  • Spinal shock - neurologic phenomena loss of all neurolgoic function in the acute phase of a SCI > lasts < 24 hrs
Management
  • Optimizing return of neurologic function - immobilization - variable evidence; avoiding hypotension, hypoxemia, and hyperthermia

  • Neurologic HPI - details of event causing injury, transient or persistent numbness weakness or paresthesias, neck or back pain, prior history of spinal stenosis - predisposes to central cord, arthritis, previous spinal fusion

  • Airway management - intubate fast and early > C3-C5 = diaphragm; patient can recruit some accessory muscles but won't last long

  • Make sure neurogenic hypotension is a diagnosis of exclusion in the trauma patient - these patient's shouldn't be tachcyardic with hypotension and they should have obvious signs of spinal cord injury

  • Neurogenic hypotension - typically respond to Trendelenburg position & IVF

       >  Avoid phenylephrine as a pressor (concern over reflex bradycardia); Choose NE vs dopamine

  • Acute complete cord injury - reduced sensation reduced muscle power

  • Incomplete injury - various degree of motor function; sensation preserved more than motor; bulbocavernosus reflex & anal sensation spared

  • Transient paralysis & spinal shock - younger athletes - will look like a complete injury & can have neurogenic hypotension

  • Incomplete spinal cord lesions - central cord (most commons incomplete SCI) - forced hyperextension - paresis upper > lower;  anterior cord - flexion injuries - paralysis and hypalgesia below level of injury; preservation of posterior column - vibration pressure light touch and proprioception; brown sequard - penetrating lesions - ipsilateral motor paresis, loss of vibration pressure and all propioception; contralateral sensory hypesthesia

  • C5 - elbow flexed, C6 wrist extension; C7 elbow extensor, C8 finger flexors, T1 - finger abduction; know your cord levels and dermatomes!
  • "Jefferson bit off a hangmans thumb" - unstable C spine fractures

        - Jefferson - axial load - classic diving injury - unstable fracture

        - Bifacet dislocation

        - Type II odontoid fracture

        - Hangmans fracture - distraction & rotation injury - posterior element of C2 gets fractured & spondylolisthesis of axis

        - Flexion Teardrop - most serious of all Cspine fractures


0 Comments

Your comment will be posted after it is approved.


Leave a Reply.

    Archives

    August 2018
    February 2018
    January 2018
    December 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013

    Categories

    All
    Abdominal Pain
    Abdominal-pain
    Airway
    Back Pain
    Back Pain
    Bleeding
    Change-in-mental-status
    Chest Pain
    Dizziness
    Ecg
    Emboli
    Environmental
    Fever
    Gyn
    Headache
    Hypertension
    Infectious Disease
    Pain
    Pediatric Emergency
    Professionalism
    Psych
    Respiratory Distress
    Sepsis
    Shock
    Toxins
    Trauma
    Vomiting
    Weakness

    RSS Feed

    Tweets by @PedEMMorsels
Powered by Create your own unique website with customizable templates.
  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction