As the kids say, I’m shook

Actually shocked, shooked, shooken, shicked, shucked, stucked, chuffed. Are some of those not words? Probably. Do I care? Not a chance buddy. But that actually has something to do with the subject and f the post. What? Getting to the point right away? I don’t think John wrote this. Shocker, I did. And it’s shock. 

Specifically neurogenic shock. In short, shock is less oxygen and/or more oxygen use and/or ineffective oxygen use leading to hypoxia and tissue death. If you remember my wise words from the Tetralogy of Fallot post, oxygen is important kinda. This can happen for a few reason but today it’s neurological. When I hear neuro I think brain and nerves and spine, which give you a clue to the cause. 

I’ll call it NS now, to to be confused with normal saline or not so or never seen or new spatula. NS is classified as distributive shock, that is the body’s logistics system isn’t working. Kinda like ours. Anyways, this means even if you’re getting oxygen in, it doesn’t make it to the tissues like Amazon delivering in a blizzard. 

Ok what’s the deal? When the autonomic nervous system starts to haywire, your body isn’t able to regulate blood vessel diameter, AKA the container gets bigger. This usually happens with cervical or upper thoracic spine injuries. Think about a full spinal severing, the muscles below that spot don’t work. Blood vessels have muscle, but I still haven’t figured out how to get them to do curls, so similar things happen. 

Generally the higher up this injury is, the worse the shock. Think of the percent of vessels below your sternum versus below your umbilicus or below your neck. The more damage the more damage. Yes I meant to say that. What causes this injury? I normally think of trauma like a car crash or gun shot, but there really are 10,000 ways to die. Tumors, GBS, neuropathy, and spinal anesthesia are just a few of those 10,000 ways. Electrolyte shifts causing edema and toxins are also included in the list. Anything that is messing with the spinal cord. 

With all this mayhem, parts of the nervous system begin to run unopposed and cause havoc. The parasympathetic nervous system kicks in the “rest and digest” mode. This leads to the major difference in initial symptoms as compared to other shock, bradycardia. Normally, the heart has to pick up the slack left by the dilated vessels and its v-tech kicks in causing tachycardia. But the parasympathetic nervous system doesn’t let this happen. So they get hypotension and bradycardia, since the heart can’t even try to compensate. 

As a sports medic, thankfully never seeing this in person, I look at the MOA, mall of America or minute of angle or mechanism of injury. What happened? Is it likely that the spine was injured? Next, what is the patient like? Loopy? Flushed warm skin? Can’t move limbs or tingling in the limbs? Are they bleeding a lot? 
Keeping the spine safe is the first action; to prevent the situation from becoming more FUBAR. Side note, before you think about this just check if they’re bleeding out please. Hemorrhagic shock is more common. Then you have to go after the issues talked about above. 

Ok less blood/oxygen getting where it needs to go because the container is bigger due to dilation. Fluids go in. Oxygen is given. Vasopressors may be given. That’s all good but also, what am I supposed to do? I’m the nurse. Spinal precautions. Don’t make it worse than it has to be. Log rolling, C collars. Safe moving practices. Look for changes, did we fix the hypotension and flood the lungs? How long have they been in bed and have they been getting moved? Have distal parts started to become blue? How about doing some ROM? 

All that goodness written down just so I get a refresher before my final exam and boards. Yup. But be honest, who doesn’t find shock interesting? I’ll look at the others later. Septic shock would be a good companion to my antibiotic rants but I’ll save that for now. Please share this and the podcast which is on iTunes and Spotify and check out my Instagram @occasionally_preposterous and Twitter @preposterjohn. Love y’all. Bye bye. 
References 

Image of a severed spinal cord from Wikipedia. 

Shock and Neurogenic shock from StatPearls at the NIH National Library of Medicine 

Spinal Shock (nursing) also from the NIH National Library of Medicine’

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