I. Pathophysiology

  1. Hypotension secondary to CNS dysfunction but may have normal or CO and O2 delivery
  2. Most commonly seen with trauma, so often a combination of shocks
  3. Usually results from loss of sympathetic function from interruption close to origin, leading to vasodilation, SVR, may venous return

II. Diagnosis

  1. Hypotensive trauma victim with slow or normal heart rate, warm extremities, little or no agitation
  2. Mechanism of injury, depressed LOC, loss of gross motor function
  3. Rule out other causes of shock
  4. Labs
    1. No acid-base, Hgb, or renal abnormalities

III. Management

  1. Attention to maintaining adequate volume
  2. Vasopressors may be needed
  3. May (rarely) require neurosurgical intervention