How is hemorrhagic shock differentiated from neurogenic shock in spinal cord injury (SCI)?

Updated: Nov 01, 2018
  • Author: Lawrence S Chin, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
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Answer

The following are clinical "pearls" useful in distinguishing hemorrhagic shock from neurogenic shock:

  • Neurogenic shock occurs only in the presence of acute spinal cord injury above T6; hypotension and/or shock with acute spinal cord injury at or below T6 is caused by hemorrhage

  • Hypotension with a spinal fracture alone, without any neurologic deficit or apparent spinal cord injury, is invariably due to hemorrhage

  • Patients with a spinal cord injury above T6 may not have the classic physical findings associated with hemorrhage (eg, tachycardia, peripheral vasoconstriction); this vital sign confusion attributed to autonomic dysfunction is common in spinal cord injury

  • The presence of vital sign confusion in acute spinal cord injury and a high incidence of associated injuries requires a diligent search for occult sources of hemorrhage


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