CuraRN

Neurogenic Shock

Student study notes from paramedic coursework (2023 to 2024), not medical advice. Verify clinical values against current references and your local protocols.

EMS etiologies

Setting: ER

Neurogenic shock is a type of distributive shock resulting from a disruption in the autonomic nervous system, commonly caused by spinal cord injuries, particularly above the 6th thoracic vertebra, or traumatic brain injuries. It occurs due to the loss of sympathetic nervous system (SNS) tone, which leads to vasodilation, causing blood to pool in the extremities and leading to hypotension (low blood pressure). Additionally, the vagal response becomes unopposed by the SNS, leading to bradycardia (slow heart rate). Neurogenic shock is a medical emergency that, if left untreated, can result in organ dysfunction and death.

Clinical Presentation:

Key signs and symptoms include:

• Sudden hypotension due to vasodilation.
• Warm, flushed skin, reflecting the lack of vasoconstriction.
• Bradycardia, as the body cannot mount a tachycardic response.
• Respiratory issues, depending on the level of spinal injury (e.g., diaphragmatic breathing or respiratory arrest if the injury is above C3).
• Dizziness, anxiety, and labored breathing.
• Priapism due to unopposed vasodilation.

Treatment Modalities:

Treatment focuses on restoring blood pressure and heart rate using vasopressors and medications. Common treatments include:

• Norepinephrine as the first-line vasopressor to raise blood pressure.
• Dopamine in combination with other vasopressors.
• Vasopressin, sometimes used alongside norepinephrine.
• Atropine for managing bradycardia, though it is ineffective in heart transplant patients.

Prompt recognition and treatment of neurogenic shock are critical to prevent organ failure and improve patient outcomes.