Brian Euerle Thomas M. Scalea
Neurogenic shock, characterized by hypotension and bradycardia, occurs after an acute spinal cord injury that disrupts sympathetic outflow, leaving unopposed vagal tone.1 The term neurogenic shock must be carefully differentiated from another that has a very different meaning—namely, spinal shock. Spinal shock refers to the temporary loss of spinal reflex activity that occurs below a total or near total spinal cord injury. 2 These terms are not interchangeable. This chapter focuses on neurogenic shock.
The vast majority of patients who sustain a spinal cord injury are initially evaluated in an emergency department (ED). Although the definitive care of these patients is provided by a variety of specialists, the emergency physician usually performs the initial evaluation, resuscitation, stabilization, and transfer. The patient's prognosis and eventual outcome depend on initial ED care. Early recognition of the potential injury, along with early spinal immobilization, will help prevent any possible worsening of an injury. For high-dose methylprednisolone therapy to be effective, it should be given within 8 h of injury. 3 The search for associated injuries must be done early, often by the emergency physician.
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