How would you answer this question?
The patients at highest risk for neurogenic shock are those who have had
a. a stroke.
b. a spinal cord injury.
c. Guillain-Barré syndrome.
d. a craniotomy.
The correct answer is "b" spinal cord injury.
The patients at highest risk for neurogenic shock are those who have had a spinal cord injury above the level of the sixth thoracic vertebra (T6). When this happens, the patient loses the background sympathetic nervous system stimulation of the body and allows the parasympathetic system to continue without balance.
The sympathetic system maintains vascular tone and maintains blood pressure. When a patient has a spinal cord injury above T6, innervation of the sympathetic system is lost to the heart and vascular tone is lost, causing vasodilation and decreased blood pressure.
The parasympathetic system causes bradycardia and hypotension, which leads to shock from a maldiistribution of blood into the periphery and less blood flow coming back to the heart. This causes hypotension and shock. The key defining characteristic of neurogenic shock is bradycardia. Look for the slow heart rate to find neurogenic shock. Other defining characteristics include warm and dry skin. Other kinds of shock are associated with cold and clammy skin.
From: Guly, H.R., Bouamra, O., & Lecky, F.E. (2008). The incidence of neurogenic shock in patients with isolated spinal cord injury in the emergency department. Resuscitation, 76(1), 57-62.
Congratulations to Lee Anne Bruce who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly. Congratulations Lee Anne!
Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.
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