Question

Ms. L, a 19-year-old woman with no previous medical history, was involved in a serious automobile accident in which her best friend died. Examination by EMT personnel first on the scene revealed she had only minor scrapes and bruises and no sign of head trauma. While en route by ambulance to the hospital, Ms. L complained of thirst and appeared restless. Further examination indicated a rapid pulse and respirations, with her blood pressure now at 100/60 mm Hg. She appeared less responsive to the paramedics. She was slipping into circulatory shock as they checked her again for internal injuries.

Discuss the contributing factors to shock in this case and the pathophysiologic changes causing the changes in vital signs.(See Shock—Neurogenic.)

Answer 1

ANSWER.

* Contributing factors of shock in this patient.

            * Spinal cord injury due to automobile accident.

            * Internal bleeding as a result of trauma.

            * Damages occur in the central nerve system and

              autonomic nerve system.

* Pathological changes causing changes in vital signs.

          * Injury or trauma of the spinal cord affect the normal

              functioning of sympathetic nerve system and autonomic

              nerve system.

          * Both Sympathetic and autonomic nerve system has a role in regulation

   of blood pressure,heart rate and respiration.

            * Changes occur in the normal functioning of sympathetic and autonomic

               system due to spinal cord injury result in changes in vital signs

               and blood circulation.

            * Internal bleeding from trauma also result in sudden drop in blood

              pressure,rapid pulse and respiration.

              

Answer 2

Shock is a systemic state resulting from an imbalance between cellular oxygen supply and demand. Due to insufficient supply of oxygen cells switch to anaerobic metabolism. If perfusion is not restored in time, cell death follows.

Contributing factor in this case

The shock seen in this case, is neurogenic shock due to generally cervical spinal cord injury (above the level of sympathetic outflow from the thoracic segments). This leads to disruption of sympathetic outflow tracts.

Pathophysiology of the changes seen in this case

• Loss of noradrenaline (norepinephrine) mediated vasoconstriction - > systemic vasodilation - > decreased peripheral resistance - >lowering of blood pressure
• Decreased blood pressure - > baroreceptor reflex - > increased heart rate (tachycardia), this is an attempt to restore the cardiac output
• Decreased tissue perfusion - > increase in anaerobic metabolism - > increased lactic acid production - > metabolic acidosis - > tachypnea (respiratory effort to correct acidosis) ​​​​​​
• Anxiety and thirst is due to decreased cerebral blood flow/perfusion

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