Podcast #168: GSW with Neurogenic Shock


9f97856c-43b7-48c2-8b2f-b915b1ba4316Run Time:  4 minutes

Author: Aaron Lessen M.D.

Educational Pearls:

  • Some of the main causes of hypotension in a trauma patient are hypovolemia, hemorrhagic shock, tension pneumothorax, and cardiac injury (including pericardial effusion). However; a patient with a gunshot wound presents to the ED with a SBP in the 90s, a HR in the 120s, 300mL of fluid from the chest tube, and on a dopamine drip, which is unusual for a trauma patient.
  • After a neurologic exam was performed on the patient, the patient was unable to move his lower extremities. The patient was sent to CT scan which showed that the bullet traversed from the right clavicle to the T12 vertebral body.
  • Another cause of shock in a trauma patient is Neurogenic shock, where the spinal cord loses sympathetic tone causing the blood vessels to dilate.
  • Treatment of neurogenic shock is different than other causes of shock in trauma. Usually early IV fluids and vasopressors are used for blood pressure support until the sympathetic nervous system responds. Classically Levophed is used, but other patients may respond better to other vasopressors.
  • Neurogenic shock is a diagnosis of exclusion. Other causes of traumatic shock that need more aggressive treatment should be considered first before jumping to treating neurogenic shock.

Link to Podcast:  http://medicalminute.madewithopinion.com/gsw-with-neurogenic-shock/#

References: http://www.jems.com/articles/print/volume-39/issue-11/features/assessment-and-treatment-spinal-cord-inj.html

http://www.cdc.gov/TraumaticBrainInjury/index.html

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