Soc neurogen

Hipotensiune si bradicardie aparute dupa lez acuta a maduvei spinarii cu intreruperea influxului simpatic
(nu mai prezinta tahicardie compensatorie => daca avem un p cu semne clinice de soc, istoric de trauma,
hipotensiv si bradicardic => lez acuta la niv maduvei)
Soc spinal- intreruperea temporara a activitatii reflexe medulare aparuta dupa o lez a maduvei spinarii
Epidemio: traumatisme inchise (accidente rutiere, moto), traumatisme deschise (arme albe, arme de foc)

Fiziopatologie
Eveniment traumatic: compresiune, dilacerarea maduvei
Lez medulare secundare (zile-sapt) - ischemie, lez arteriale locale, tromboza intraarteriale
Pierderea tonusului simpatic cu accentuarea celui simp
Hipotensiune, bradicardie
Ex clinic: vasodil - tegumente calde

Tablou clinic
Context traumatic (traumatism inchis/deschis)
Hipotensiune cu teg calde si uscate, posibil hipotermie
Bradicardie
Lez mai sus de T1 - blocare intreg SNVS
Lez T1-L3 intrerupere partiala SNVS
Tablou diferit in traumatisme pentrante (componenta hemoragica-soc hemoragic)
Putem intalni si 2 tipuri de soc obstructiv extracardiac

Tratament
A- Protectia coloanei cervicale (guler cervical, transportul p cu saltea vacuum - perm mobilizarea fara risc a
p si imobolizeaza in pozitia in care ne dorim sa imobolizam, tot corpul/ sau cu targa rigida)
B- Ventilatie, oxigenare (oxigenoterapie/ IOT)
C- Resuscitare cu fluide: cristaloide 20ml-40ml/kgc
D- Evaluare neurologica - calc scor de coma Glasgow, reflexe
E- Expunerea la factorii de mediu
Eval secundara a p cu trauma
Corticoterapie - controversata (nu este o idee buna daca este sectionata maduva, ci doar intr-un proces
inflamator,antialgic)- metilprednisolon 30 mg/kg in prima ora, apoi 5.4 mg/kg/h, 23 h
F- Suport vasopresor(vrem sa crestem TA prin cresterea rezist vasc perif) - dopamina (2.5-20mcg/kg/min in
perfuzie continua pe injectomat), dobutamina
SOC OBSTRUCTIV

Tamponade physiology is classified under obstructive shock. It is most common after penetrating
trauma. Pericardial fluid (blood) compresses the myocardium and inhibits diastolic filling. Patients may
develop cardiogenic shock as the myocardium is stressed against the obstruction. Cardiac
tamponade occurs when fluid accumulates in the pericardial sac 

 In the case of an acute pulmonary embolism an intravascular occlusion results in an acute increase of the
right ventricular afterload.

In the case of a tension pneumothorax, an obstruction of the blood vessels supplying the heart is caused
by an increase in extravascular pressure
Pneumothorax is when air collects in between the parietal and viscera pleurae resulting in lung collapse. It
can happen secondary to trauma (traumatic pneumothorax). When mediastinal shifts accompany it, it is
called a tension pneumothorax.Tension pneumothorax develops when air continuously enters the
chest without evacuation.
https://www.youtube.com/watch?v=TcwuC8zbEzc

Tahipnee vs. Polipnee: ambele sunt respiratii cu frecventa cerscuta, tahipneea presupune un volum

respirator normal sau crescut, polipneea are un volum respirator scazut (respiratiile alea dese NU iti ofera
suficient oxigen

When the phrenic nerve is injured, the electrical signals in it stop traveling from the brain to the
diaphragm muscle. The diaphragm muscle turns off and the patient may have difficulty breathing.
The diagnosis of phrenic nerve injury requires high suspicion due to nonspecific signs and symptoms
including unexplained shortness of breath, recurrent pneumonia, anxiety, insomnia, morning
headache, excessive daytime somnolence, orthopnea, fatigue, and difficulty weaning from mechanical
ventilation.