Expansion
Hypotension with bradycardia and warm peripheries after high spinal cord injury
Expansion
Caused by injury above about T6, interrupting sympathetic outflow from the thoracolumbar cord while leaving vagal supply intact.
Features:
- Hypotension, from loss of arteriolar and venous tone
- Bradycardia, because unopposed vagal tone acts on the heart
- Warm, dry, well-perfused peripheries
- Normal or wide pulse pressure
The bradycardia is the key discriminator. Every other form of shock in a trauma patient produces tachycardia, so hypotension with a slow heart rate should prompt examination for a cord injury.
Management is fluid resuscitation with early vasopressors, since the problem is tone rather than volume, and atropine or pacing for symptomatic bradycardia.
Distinguish it from spinal shock, a different concept, meaning transient loss of all reflexes and flaccid paralysis below the level of a cord injury.