let's think now about the management of
neurogenic shock and first of all I want
to think about spinal shock that may
develop after a spinal cord injury
now this can last for a few hours to a
few weeks but eventually it goes because
the space that the patient develops
spinal reflexes that will start to
stimulate the the heart again and cause
vasoconstriction again so it does pass
off after a period of time but in the
meantime the patient might need to be
managed in a flat position so their
brain is perfused and they may need
drugs to maintain their blood pressure
such as inotropes
such as dopamine or vasopressin drugs
such as noradrenaline just for a period
of time but much more commonly we're
going to come across vasovagal syncope
simple fainting
now this can occur for emotional reasons
where it can occur because of pain let's
take pain as an example if the patient's
having vasovagal syncope they're losing
their blood pressure as a result of pain
because the parasympathetic stimulation
is going to overwhelm the sympathetic
stimulation of the heart and the blood
vessels well the best way to manage this
is simply to reduce the amount of pain
the patient's got so the patient's got a
fracture we can immobilize that fracture
or put traction on that fracture if we
can think about the cause of the pain
and remove the cause of that pain it
might be something as simple as
adjusting the patient's position in bed
to reduce the pain simple measures to
take away the cause of the pain of the
ideal management of this condition but
if we can't do that then we're going to
go to give analgesic drugs to take away
the pain so if someone's got a fracture
we might give them an antiemetic and say
titrate titrating 10 milligrams of
morphine for example a drug - to deal
with the pain and then when you take
away the pain the vasovagal syncope will
also usually go as well and people faint
very commonly and isn't
to worry about all we do is lie them
down get their head down so the blood is
going downhill
sometimes prop the feet up to increase
venous return and then normally come
around with it within a few seconds as
soon as we lie them down so they so
vagal syncope moneyman is that basically
with common sense lighting them down
cool them if you can give them a drink
of water anything like that
it seemed simple but it's actually
important because if you don't lie these
patients down if someone has just a
vasovagal attack and they're topped up
will go unconscious and because their
proctor the blood supply to the brain
can actually drop quite dramatically and
that can mean that the brain becomes
irritated so the patient has a simple
vasovagal syncope but it's not allowed
to lie down there propped up or they're
stuck in a crowd or they're sitting up
for some reason then you can start to
fit they can have grand mal type fits as
a result of the cerebral hypoxia so very
simple but very important to manage it
correctly
you