Shock Solution 11

Clinical Scenario 11

A 27 year old male is involved in an motor vehicle accident. He sustains a burst fracture of T2 with complete neurological deficit below this level. Fours hours following admission his SpO2 is 85%, his blood pressure is 80/40 and his heart rate is 45.

This unfortunate young man has spinal shock as a result of disruption of both the spinal cord and the sympathetic tract. He is hypotensive due to loss of sympathetic tone to the lower part of his body, and bradycardic, due to loss of his cardioaccelerator nerves. He has relative hypovolemia, and inability to compensate. The treatment initially is airway protection and volume loading, with blood/colloid, as necessary. If this is insufficient to restore the blood pressure, this patient will require a systemic sympathetic analogue to tighten up his blood vessels and increase his heart rate: the choice is either dopamine or epinephrine. Dx: distributive shock, loss of vasomotor tone, relative hypovolemia, inappropriate heart rate.