DOCSLIB.ORG

Cervical Spinal Cord Injury and the Need for Cardiovascular Intervention

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cervical Spinal Cord Injury and the Need for Cardiovascular Intervention PAPER Cervical Spinal Cord Injury and the Need for Cardiovascular Intervention John F. Bilello, MD; James W. Davis, MD; Mark A. Cunningham, MD; Tammi F. Groom, PA-C; Debbie Lemaster, BSN; Lawrence P. Sue, MD Hypothesis: The level of cervical spinal cord injury Results: Eighty-three patients met the criteria for CSCI (CSCI) can be used to predict the need for a cardiovas- and quadriplegia, 62 in the high (C1-C5) and 21 in the cular intervention. low (C6-C7) level. There was no significant difference between the 2 groups in mean±SD age (38.2±17.8 vs Design: Retrospective review. Data included level of spi- 34.7±15.6 years; P=.43), mean±SD Injury Severity Score nal cord injury, Injury Severity Score, lowest heart rate, (35.7±17.5 vs 32.5±11.2; P=.44), mean±SD admission and systolic blood pressure in the first 24 hours and in- base deficit (−0.7±3.6 vs 0.7±2.7; P=.06), or mortality tensive care unit course. The level of CSCI was divided (12 [19%] of 62 patients vs 2 [10%] of 21 patients; P=.29). into high (cord level C1-C5) or low (cord level C6-C7). Neurogenic shock was present in 19 (31%) of the 62 pa- Neurogenic shock was defined as bradycardia with hy- tients with high CSCI and in 5 (24%) of the 21 patients potension. Statistical analysis was performed with the with low CSCI (P=.56). There was a marked difference t test and the ␹2 test. in the use of a cardiovascular intervention between those with a high and those with a low CSCI: 15 (24%) of 62 Setting: Level I trauma center. patients vs 1 (5%) of 21 patients (P=.02). Two patients with C1 through C5 spinal cord injuries required car- Patients: The patients studied were those with quad- diac pacemakers. riplegia who experienced a CSCI and were admitted to the hospital between December 1, 1993, and October 31, Conclusions: There was no significant difference in the 2001. frequency of neurogenic shock by injury level. Patients with a high CSCI (C1-C5) had a significantly greater re- Interventions: Pressors, chronotropic agents, and pace- quirement for a cardiovascular intervention compared makers. with patients with lower injuries (C6-C7). Main Outcome Measure: Use of a cardiovascular in- tervention in the presence of neurogenic shock. Arch Surg. 2003;138:1127-1129 ERVICAL SPINAL cord in- heart itself.4 Pharmacologic and electri- jury (CSCI) is associated cal interventions (ie, pacemakers) may be with dysfunction of the necessary in these patients if fluid resus- sympathetic nervous sys- citation alone cannot maintain adequate tem and cardiovascular tissue perfusion. Failure to adequately treat Cdeficits, including severe bradycardia, asys- neurogenic shock may result in further is- tole, and loss of peripheral vascular tone. chemic injury of an already compro- These effects have been replicated in ani- mised nervous system (secondary injury).4 mal studies.1-3 Direct myocardial injury and Aggressive treatment with fluids and pres- a decrease in contractility (dp/dt [ie, change sors, and appropriate invasive monitor- in pressure per change in time]) may also ing (arterial and central venous access), is contribute to hypotension.1,3 paramount.5 Patients with a CSCI may develop To our knowledge, no study has spe- neurogenic shock, characterized by brady- cifically examined whether the level of cardia and hypotension from decreased pe- CSCI can be used to determine which pa- From the Department of ripheral vascular resistance and cardiac tients are most susceptible to neurogenic Surgery, University Medical output. These changes are related to in- shock and the requirement for cardiovas- Center, University of California creased vagal tone, decreased sympa- cular interventions (CVIs), namely, the ad- San Francisco–Fresno Campus. thetic input, and possibly changes in the ministration of pressors, chronotropic (REPRINTED) ARCH SURG/ VOL 138, OCT 2003 WWW.ARCHSURG.COM 1127 ©2003 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/30/2021 Results are expressed as mean±SD. Analysis was per- Relationship of CSCI Level to Age, ISS, formed by ␹2 test and paired t test. PϽ.05 was considered sta- Admission Base Deficit, and Mortality* tistically significant. CSCI Level RESULTS Cord Level Cord Level C1-C5 C6-C7 Variable (n = 62) (n = 21) P Value Eighty-three patients met the inclusion criteria for CSCI and quadriplegia during the study period, with 62 in the Age, y 38.2 ± 17.8 34.7 ± 15.6 .43 ISS 35.7 ± 17.5 32.5 ± 11.2 .44 high injury (C1-C5) category and 21 in the low injury Admission base deficit −0.7 ± 3.6 0.7 ± 2.7 .06 (C6-C7) category. There was no significant difference in Mortality, No. (%) 12 (19) 2 (10) .29 age, Injury Severity Score, admission base deficit, or mor- tality between the groups (Table). Abbreviations: CSCI, cervical spinal cord injury; ISS, Injury Severity Score. There was no significant difference in the presence *Data are given as mean ± SD unless otherwise indicated. of neurogenic shock between the C1 through C5 group and the C6 through C7 group (19 [31%] of 62 patients agents, and/or cardiac pacing. This study was per- vs 5 [24%] of 21 patients; P=.56). However, there was a formed to test the hypothesis that the level of CSCI can significant difference between the 2 groups in the need be used to predict the likelihood of requiring a CVI. for a CVI: 15 (24%) of the C1 through C5 group re- quired an intervention for neurogenic shock, whereas only METHODS 1 (5%) of the C6 through C7 group needed an interven- tion (P=.02). In addition, the only 2 patients requiring The records of quadriplegic patients who experienced a CSCI at permanent pacemakers were in the higher cervical level University Medical Center, a level I trauma center, between De- injury group. None of the patients with C6 through C7 cember 1, 1993, and October 31, 2001, were reviewed. Level of spinal cord injury, age, sex, Injury Severity Score,6 admission base injury required a pacemaker. deficit,7-9 mechanism (blunt vs penetrating), associated inju- Dobutamine was used in 2 patients. One patient was ries, hemorrhage, previous medical conditions, and in-hospital a 69-year-old woman with a history of congestive heart mortality were noted. The lowest heart rate and systolic blood failure, and the other was a 90-year-old man with a low pressure in the first 24 hours after injury and during the remain- cardiac index. Both patients met invasive criteria for ino- ing intensive care unit course were recorded. All resuscitations tropic support, and both also required a vasoconstric- followed Advanced Trauma Life Support guidelines.10 Initial hy- tive agent (dopamine or phenylephrine hydrochloride potension was treated with crystalloid, followed by packed red [Neo-Synephrine]). blood cells as appropriate and control of hemorrhage. Resusci- tation was guided by response to therapy and the end points of systolic blood pressure of 90 mm Hg or higher, no further need COMMENT for transfusion, and correction of base deficit. Pressors and chro- notropic agents were used only when hypotension was refrac- Cervical spinal cord injury can cause significant changes tory to intravenous fluid administration, and were titrated to keep in pulse, blood pressure, cardiac output, and rhythm. the systolic blood pressure at 90 mm Hg or higher. All patients who began treatment with pressors and chronotropic agents un- Within seconds to minutes after injury, there is a sys- derwent placement of central venous and/or pulmonary artery temic pressor response with a widened pulse pressure seen catheters and invasive arterial monitoring. in animals and humans, resulting from short-term out- The level of CSCI was divided into 2 categories: high (cord flow of sympathetic activity and adrenal hormones. This level C1-C5) and low (cord level C6-C7). C5/C6 was chosen pressor response quickly abates, and is followed by neu- as the level of division between the 2 categories because of in- rogenic shock with bradycardia and hypotension.11,12 nervation of the phrenic nerve, which terminates at the C5 level. Preganglionic sympathetic nerve fibers exit the spinal cord Previous researchers11,12 have used this level as the line of de- at the first through fourth thoracic level. Parasympa- marcation because of the respiratory pathophysiological fea- thetic outflow, however, is carried by the vagus nerve, tures that may contribute to neurogenic shock. Bradycardia was which originates in the medulla. Therefore, a CSCI may defined as a heart rate of less than 50 beats/min. Hypotension was defined as a systolic blood pressure lower than 90 mm Hg. completely transect spinal cardiac and vasomotor sym- Neurogenic shock was defined as the presence of simulta- pathetic fibers from above while the parasympathetic fi- 11,12,16-18 neous bradycardia and hypotension. The use of pressors (dopam- bers remain intact. We chose C5/C6 as the bor- ine hydrochloride, dobutamine hydrochloride, epinephrine hy- der between high and low cervical injuries because phrenic drochloride, norepinephrine bitartrate, and phenylephrine nerve innervation terminates at C5. Piepmeier11 and hydrochloride), chronotropic agents (atropine sulfate), and car- Lehmann12 and colleagues invoke hypoxia as a culprit diac pacing was recorded. Use of 1 or more of these treatments in the exacerbation of bradycardia and cardiac arrest in constituted a CVI. Patients with a CSCI from blunt trauma were patients with cervical cord injuries. Piepmeier et al fur- 13 given intravenous methylprednisolone sodium succinate. Pa- ther explain that hypoxic patients with normal cervical tients with a CSCI who experienced penetrating trauma did not cord function will increase their heart rate with the sym- receive corticosteroids.14,15 The Injury Severity Score is an expression of anatomic in- pathetic outflow that normally accompanies hypoxic- jury developed for comparison of trauma care that correlates induced tachypnea (pulmonary inflation reflex).
Load more

Recommended publications
  • Approach to Shock.” These Podcasts Are Designed to Give Medical Students an Overview of Key Topics in Pediatrics
    PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on “Approach to Shock.” These podcasts are designed to give medical students an overview of key topics in pediatrics. The audio versions are accessible on iTunes or at www.pedcases.com/podcasts. Approach to Shock Developed by Dr. Dustin Jacobson and Dr Suzanne Beno for PedsCases.com. December 20, 2016 My name is Dustin Jacobson, a 3rd year pediatrics resident from the University of Toronto. This podcast was supervised by Dr. Suzanne Beno, a staff physician in the division of Pediatric Emergency Medicine at the University of Toronto. Today, we’ll discuss an approach to shock in children. First, we’ll define shock and understand it’s pathophysiology. Next, we’ll examine the subclassifications of shock. Last, we’ll review some basic and more advanced treatment for shock But first, let’s start with a case. Jonny is a 6-year-old male who presents with lethargy that is preceded by 2 days of a diarrheal illness. He has not urinated over the previous 24 hours. On assessment, he is tachycardic and hypotensive. He is febrile at 40 degrees Celsius, and is moaning on assessment, but spontaneously breathing. We’ll revisit this case including evaluation and management near the end of this podcast. The term “shock” is essentially a ‘catch-all’ phrase that refers to a state of inadequate oxygen or nutrient delivery for tissue metabolic demand. This broad definition incorporates many causes that eventually lead to this end-stage state. Basic oxygen delivery is determined by cardiac output and content of oxygen in the blood.
    [Show full text]
  • Definition Shock Is a Life-Threatening Condition That Occurs When the Body
    Shock Definition Shock is a life-threatening condition that occurs when the body is not getting enough blood flow. This can damage multiple organs. Shock requires immediate medical treatment and can get worse very rapidly. Considerations Major classes of shock include: • Cardiogenic shock (associated with heart problems) • Hypovolemic shock (caused by inadequate blood volume) • Anaphylactic shock (caused by allergic reaction) • Septic shock (associated with infections) • Neurogenic shock (caused by damage to the nervous system) Causes Shock can be caused by any condition that reduces blood flow, including: • Heart problems (such as heart attack or heart failure ) • Low blood volume (as with heavy bleeding or dehydration ) • Changes in blood vessels (as with infection or severe allergic reactions ) Shock is often associated with heavy external or internal bleeding from a serious injury. Spinal injuries can also cause shock. Toxic shock syndrome is an example of a type of shock from an infection. Symptoms A person in shock has extremely low blood pressure. Depending on the specific cause and type of shock, symptoms will include one or more of the following: • Anxiety or agitation • Confusion • Pale, cool, clammy skin • Bluish lips and fingernails • Dizziness , light-headedness, fainting or unconsciousness • Profuse sweating , moist skin • Rapid but weak pulse • Shallow breathing • Chest pain First Aid • Call 911 for immediate medical help. • Check the person's airways, breathing, and circulation. If necessary, begin rescue breathing and CPR. • Even if the person is able to breathe on his or her own, continue to check rate of breathing at least every 5 minutes until help arrives. • If the person is conscious and does NOT have an injury to the head, leg, neck, or spine, place the person in the shock position.
    [Show full text]
  • Shock, Damage Control Resuscitation, and Vascular Access
    Shock, Damage Control Resuscitation, and Vascular Access Chapter 7 Shock, Damage Control Resuscitation, and Vascular Access Introduction The goal of resuscitation is to maintain adequate perfusion. Resuscitation of the wounded combatant remains a formidable challenge on the battlefield. Resuscitation begins with the placement of two large-bore IVs (16 or 18 G). The vast majority of casualties do not need any IV fluid resuscitation prior to arrival at a forward medical treatment facility. For the more seriously injured trauma patients in the presurgical setting, the goal is to deliver the patient to a surgical facility expeditiously while maximizing the patient’s chances of survival. This is accomplished using damage control resuscitation (DCR) principles at point of injury (POI), Role 1, and Role 2 facilities in order to mitigate the lethal triad of acidosis, hypothermia, and coagulopathy. For the approximately 10% of casualties who constitute the most seriously injured, are in shock and coagulopathic, and represent potentially preventable hemorrhagic deaths, blood products should be part of the initial fluid resuscitation. This chapter will briefly address shock (including recognition, classification, treatment, definition, and basic pathophysiology), review initial and sustained fluid resuscitation, summarize currently available fluids for resuscitation, and describe vascular access techniques. Recognition and Classification of Shock Shock is a clinical condition marked by inadequate organ perfusion and tissue oxygenation, manifested by poor skin turgor, pallor, cool extremities, capillary refill greater than 2 seconds, anxiety/confusion/obtundation, tachycardia, weak or thready pulse, and hypotension. Lab findings include base deficit >5 and lactic acidosis >2 mmol/L. 73 Emergency War Surgery Hypovolemic shock: Diminished volume resulting in poor perfusion as a result of hemorrhage, diarrhea, dehydration, and burns.
    [Show full text]
  • Lynn Fitzgerald Macksey
    SHOCK STATES Lynn Fitzgerald Macksey RN, MSN, CRNA Define SHOCK : a state where tissue perfusion to vital organs is inadequate. Shock state In all shock states, the ultimate result is inadequate tissue perfusion, leading to a decreased delivery of oxygen and nutrients to cells…. and, therefore, cell energy. Clinical recognition of shock Symptoms dizziness, nausea, visual changes, thirst, dyspnea Signs cold clammy skin, pallor, confusion, agitation, diaphoresis, weak thready pulse, obvious injury Compensatory stages of shock Sympathetic nervous system Renin-angiotensin system Pituitary-antidiuretic hormone release Shunting from less critical areas to brain and heart Progressive decompensation Failure of compensatory mechanisms in Bowel CNS & autonomic Heart Kidneys Lungs Liver What will we see? Shock diagnosis Clinical examination Diagnostics: CXR CBC blood chemistry EKG ABG vital signs Monitoring organ perfusion in shock states Base deficit Blood lactate levels Normalization of these markers are the end point goals of resuscitation! Base Deficit Reflects severity of shock, the oxygen debt, changes in oxygen delivery, and the adequacy of fluid resuscitation. 2-5 mmol/L suggests mild shock 6-14 mmol/L indicates moderate shock > 14 mmol/L is a sign of severe shock Base Deficit The base deficit reflects the likelihood of multiple organ failure and survival. An admission base deficit in excess of 5-8 mmol/L correlates with increased mortality. Lactate Levels Blood lactate levels correlate with other signs of hypoperfusion. Normal lactate levels are 0.5-1.5 mmol/L >5 mmol/L indicate significant lactic acidosis. Lactate Levels Failure to clear lactate within 24 hours after circulatory shock is a predictor of increased mortality.
    [Show full text]
  • A Systematic Review of the Evidence Supporting a Role for Vasopressor Support in Acute SCI
    Spinal Cord (2010) 48, 356–362 & 2010 International Spinal Cord Society All rights reserved 1362-4393/10 $32.00 www.nature.com/sc REVIEW A systematic review of the evidence supporting a role for vasopressor support in acute SCI A Ploumis1,2, N Yadlapalli2, MG Fehlings3, BK Kwon4 and AR Vaccaro2 1Division of Orthopaedics and Rehabilitation, Department of Surgery, University of Ioannina, Ioannina, Greece; 2Department of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA; 3Division of Neurosurgery and Spinal Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada and 4Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada Study design: A systematic review of clinical and preclinical literature. Objective: To critically evaluate the evidence supporting a role for vasopressor support in the management of acute spinal cord injury and to provide updated recommendations regarding the appropriate clinical application of this therapeutic modality. Background: Only few clinical studies exist examining the role of arterial pressure and vasopressors in the context of spinal cord trauma. Methods: Medical literature was searched from the earlier available date to July 2009 and 32 articles (animal and human literature) answering the following four questions were studied: what patient groups benefit from vasopressor support, which is the optimal hypertensive drug regimen, which is the optimal duration of the treatment and which is the optimal arterial blood pressure. Outcome measures used were the incidence of patients needing vasopressors, the increase of arterial blood pressure and neurologic improvement. Results: Patients with complete cervical cord injuries required vasopressors more frequently than either incomplete injuries or thoracic/lumbar cord injuries (Po0.001).
    [Show full text]
  • Neurogenic Shock
    NEUROGENIC SHOCK Introduction Neurogenic shock is a form of circulatory shock that may occur with severe injury to the upper spinal cord. It should not be confused with spinal shock, which refers to the initial flaccid muscle paralysis and loss of reflexes seen after spinal cord injury. Pathology Neurogenic shock results from severe spinal cord injury of the upper segments. This is usually at or above the level of T4, as the sympathetic cardiac nerves arise at the level of T1-4. Spinal cord lesions below this level do not result in neurogenic shock. The cause of the circulatory compromise is due to disruption of the descending sympathetic nervous supply of the spinal cord, hence a hallmark of the condition will be hypotension together with a bradycardia. Hypotension results from: ● Bradycardia, (or at least a failure of a tachycardic response to a fall in blood pressure). ● Reduced myocardial contractility ● Peripheral vasodilation. Note that isolated intracranial injuries to the CNS do not cause circulatory shock, and if this is present in such cases then other causes of shock need to be pursued. Clinical Features Patients with neurogenic shock usually have significant associated thoracic trauma and hypovolemic shock may co-exist with neurogenic shock. Hypovolemic shock is common, and immediately life-threatening, whilst neurogenic shock is uncommon, and rarely immediately life-threatening, in isolation. In the first instance any trauma patient who has hypotension must therefore be assumed to have hypovolemia until proven otherwise. The diagnosis of neurogenic shock must necessarily be one of exclusion. The classic description of neurogenic shock is hypotension without tachycardia or peripheral vasoconstriction.
    [Show full text]
  • Trauma: Spinal Cord Injury
    Trauma: Spinal Cord Injury a, a,b Matthew J. Eckert, MD *, Matthew J. Martin, MD KEYWORDS Spine Spine trauma Spinal cord injury Spinal cord syndromes Spinal shock Spine immobilization KEY POINTS Hypotension following trauma should be considered secondary to hemorrhage until proven otherwise, even in patients with early suspicion of spinal injury. Neurogenic shock and spinal shock are separate, important entities that must be understood. Hypoxia and hypotension should be aggressively corrected because they lead to second- ary spinal cord injury, analogous to traumatic brain injury. Critical care support of multiple organ systems is frequently required early after injury. Early spinal decompression may lead to improved neurologic outcomes in select spinal cord injuries, and prompt consultation with spine surgeons is recommended. Computed tomography (CT) is the gold-standard screening study for evaluation of the spine after trauma and has significantly greater sensitivity and specificity compared with plain radiographs. High-quality CT imaging without evidence of cervical spine injury may be adequate for removal of the cervical immobilization collar in obtunded patients. INTRODUCTION Traumatic spine and spinal cord injury (SCI) occurred in roughly 17,000 US citizens in 2016, with an estimated prevalence of approximately 280,000 injured persons.1 Although the injury has historically been a disease of younger adult men, a progressive increase in SCI incidence among the elderly has been reported over the last few de- cades.2 Upwards of 70% of SCI patients suffer multiple injuries concomitant with spi- nal cord trauma, contributing to the high rates of associated complications during the acute and long-term phases of care.3 SCI is associated with significant reductions in life expectancy across the spectrum of injury and age at time of insult.1 Patients who survive the initial injury face significant risks of medical complications throughout the rest of their lives.
    [Show full text]
  • Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines
    CAEP POSITION STATEMENT DÉCLARATION DE L’ACMU Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines Dennis Djogovic, MD, FRCPC*†; Shavaun MacDonald, MD, FRCPC†; Andrea Wensel, MD†; Rob Green, MD, FRCPC‡§; Osama Loubani, MD, FRCPC‡; Patrick Archambault, MD, MSc, FRCPC¶ǁ; Simon Bordeleau, MD¶; David Messenger, MD, FRCPC, FCCP**; Adam Szulewski, MD**; Jon Davidow, MDCM, FRCPC*†; Janeva Kircher, MD†; Sara Gray, MD, FRCPC, MPH††; Katherine Smith, MD†; James Lee, MD†; Jean Marc Benoit, MD, CCFP-EM; Dan Howes, MD, FRCPC** INTRODUCTION process to help create an evidence based approach for use of these agents in the stabilization of shock. Patients may present to Emergency Departments (ED) in shock for various reasons. Shock states may be categorized as: cardiogenic, obstructive, distributive or hypovolemic. METHODS During initial resuscitation, an emergency medicine phy- sician may also have to transiently deal with undiffer- Clinical need for a set of evidence based recommen- entiated shock. While treatment of shock states is primarily dations on vasopressor and inotrope use for shock was aimed at reversing or resolving the cause of shock, emer- identified by members of C4 via informal clinical gency medicine physicians may require the use of vaso- feedback, lecture and presentation evaluation and pressors or inotropes to manage these patients. feedback and literature review. C4 itself is a hetero- Vasopressors are agents that often act to increase mean geneous group of emergency medicine physicians from arterial pressure by systemic vasoconstriction, while ino- across Canada, spanning urban, rural, tertiary and tropes primarily act to increase cardiac output through a community EDs. Although vasopressor reviews are combination of inotropy, chronotropy and afterload found in the medical literature, no evidence-based reduction.
    [Show full text]
  • Neurogenic Shock: Clinical Management and Particularities in an Emergency Room Choque Neurogênico: Manejo Clínico E Suas Particularidades Na Sala De Emergência
    THIEME 196 Review Article | Artigo de Revisão Neurogenic Shock: Clinical Management and Particularities in an Emergency Room Choque neurogênico: manejo clínico e suas particularidades na sala de emergência Daniel Damiani1 1 Department of Neuroscience, Universidade Anhembi Morumbi, Address for correspondence Daniel Damiani, MD, Instituto de São Paulo, SP, Brazil Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual, Rua Pedro de Toledo, 1800, Vila Clementino, 04039- Arq Bras Neurocir 2018;37:196–205. 000, São Paulo, SP, Brazil (e-mail: [email protected]). Abstract Neurogenic shock has a strong impact in traumatology. It is an important condition, associated with lesions in the neuraxis and can be medullar and/or cerebral. In the last years, its pathophysiology has been better understood, allowing a reduction in the morbimortality with more precise and efficacious interventions taking place in the Keywords emergency room. In this review article, the author presents the current aspects of the ► neurogenic shock management of neurogenic shock, highlighting the neuroprotective measures that ► spinal shock improve the outcome. Many pharmacologic interventions are still questionable and ► intensive care need more prospective studies to accurately assess their real value. The best moment ► spinal cord injury for neurosurgical intervention is also debatable. Quite clearly, the initial proceedings in ► head trauma the emergency room are fundamental to guarantee the adequate conditions for ► neurotrauma neuroplasticity and neuronal rehabilitation. Resumo O choque neurogênico tem um impacto considerável na traumatologia. Trata-se de uma condição importante, associada à lesão do neuroeixo, podendo ser medular e/ou cerebral. O conhecimento de sua fisiopatologia vem aumentando, permitindo assim a redução de sua morbimortalidade com intervenções mais precisas e eficazes já na sala Palavras-chave de emergência.
    [Show full text]
  • 11 Shock and Metabolic Response to Surgery
    11 Shock and Metabolic Response to Surgery Done By: Reviewed By: Nada Alouda Wael Al Saleh COLOR GUIDE: • Females' Notes • Males' Notes • Important • Additional Objectives 1. To understand physiology of sustaining blood pressure. 2. To learn about the classifications of shock. 3. To understand the consequences of the natural history of shock. 4. To be able to diagnose and plan appropriate treatments for different types of shock. Blood pressure Peripheral regulaon resistance Definion Shock and Metabolic Response to Surgery Sings/symptoms & parameters Effect of shock at Shock the organ level Hemodynamic response to shock Types of shock 1 Blood Pressure Regulation Changes in many elements regulate blood pressure (BP) and perfusion: 1. Intravascular volume. 5. Venules. 2. Heart. 6. Venous capacitance circuit. 3. Arteriolar bed. 7. Large vessel patency. 4. Capillary exchange network. Peripheral resistance (PR): • Decreased peripheral resistance: decreased arterial blood pressure (MAP = CO X PR). • Increased peripheral resistance: o Decreased venous return à o Decreased EDV à o Decreased SV à o Decreased CO (CO = HR X SV) à o Decreased arterial blood pressure (MAP=CO X PR). Heart Rate X Stroke Volume ($intravascular volume, $EDV) = Cardiac Output. Cardiac Output X Peripheral Resistance = Arterial Pressure. Arterial pressure Peripheral Cardiac resistance output Stroke volume Heart rate Abbreviations: MAP = mean arterial pressure. Peripheral Resistance: CO = cardiac output. PR = (Pa – Pv) / CO PR = peripheral resistance. * Pa = pressure in the artery. EDV = end diastolic volume. * Pv = pressure in the vein. HR = heart rate. SV = stroke volume. SVR = systemic vascular resistance. 2 Effects of those elements on BP and perfusion: 1. Intravascular volume: • Alters mean blood pressure.
    [Show full text]
  • Obstructive Shock, P
    CHAPTER 10 SHOCK OBJECTIVES KEY TERMS Upon completion of this chapter, the OEC Anaphylactic shock, p. 228 technician will be able to: Anticoagulants, p. 231 10-1 Define shock. Cardiogenic shock, p. 228 10-2 Describe the three primary causes of Distributive shock, p. 228 shock. Fainting, p. 230 10-3 Describe how the body compensates Hypovolemic shock, p. 227 for shock. Neurogenic shock, p. 229 10-4 Define the two stages of shock. Obstructive shock, p. 229 10-5 List the four major types of shock. Perfusion, p. 224 10-6 List the classic signs and symptoms of Peripheral vascular resistance, p. 226 shock. Pulmonary embolism, p. 230 10-7 Describe and demonstrate the Sepsis, p. 228 management of shock. Septic shock, p. 228 Shock, p. 224 Stroke volume, p. 226 Tachycardia, p. 226 Tachypnea, p. 226 HISTORICAL TIMELINE 1964. The NSP adopts the gold cross as its official emblem. © Jones & Bartlett Learning LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION. 9781284189599_CH10_223_238.indd 223 4/14/2020 4:37:33 PM 224 Outdoor Emergency Care, Sixth Edition CHAPTER OVERVIEW One of the most serious threats to life is the condition known as shock. Shock is defined as inadequate perfusion or flow of blood to the cells, causing cellular and tissue hypoxia due to reduced oxygen delivery. Perfusion is the circu- lation of blood within an organ or tissue in ade- quate amounts to meet the cells’ current needs for oxygen, nutrients, and waste removal. The body is perfused via the cardiovascular (circulatory) system. Although the potential causes of shock are numerous, shock occurs when one or more com- ponents of the cardiovascular system fail.
    [Show full text]
  • Neurogenic Shock ­ Humanresearchwiki Neurogenic Shock
    6/15/2016 Neurogenic Shock ­ HumanResearchWiki Neurogenic Shock From HumanResearchWiki Contents 1 Introduction 2 Clinical Priority and Clinical Priority Rationale by Design Reference Mission 3 Initial Treatment Steps During Space Flight 4 Capabilities Needed for Diagnosis 5 Capabilities Needed for Treatment 6 Associated Gap Reports 7 Other Pertinent Documents 8 List of Acronyms 9 References 10 Last Update Introduction Shock is a generalized medical state characterized by inadequate tissue perfusion leading to poor oxygenation of the tissue. Neurogenic shock specifically results from severe injury to the spinal cord or central nervous system. Sympathetic innervation from the cervical or upper thoracic spinal cord to the heart and peripheral blood vessels is lost. As a result, the patient experiences decreased heart rate (bradycardia) and vasodilation leading to severe hypotension. Treatment is a multi­faceted approach. Treatment is based on maintaining adequate tissue perfusion and oxygenation. Therefore intravenous (IV) fluids are needed, along with drugs to reverse the underlying cause. Vasopressors (i.e., phenylephrine) and atropine are needed for additional blood pressure and cardiac rate support. Neurogenic shock is an medical emergency. Clinical Priority and Clinical Priority Rationale by Design Reference Mission One of the inherent properties of space flight is a limitation in available mass, power, and volume within the space craft. These limitations mandate prioritization of what medical equipment and consumables are manifested for the flight, and which medical conditions would be addressed. Therefore, clinical priorities have been assigned to describe which medical conditions will be allocated resources for diagnosis and treatment. “Shall” conditions are those for which diagnostic and treatment capability must be provided, due to a high likelihood of their occurrence and severe consequence if the condition were to occur and no treatment was available.
    [Show full text]