doyoudig
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A 28-year-old man who was in an automobile accident is brought to the emergency department by paramedics. The patient is conscious. Clinical examination reveals no sensations below the level of the umbilicus and absent superficial and deep tendon jerks. Which of the following would be an expected finding in this patient?
A: Hypertension and tachycardia
B: Hypotension and bradycardia
C: Hypertension and bradycardia
D: Hypotension and tachycardia
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| Justice
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D: Hypotension and tachycardia
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| doc_clotaire
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D
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The elevator to succes is broke ,you must take the stairs
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| doyoudig
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| sprint123
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I am going for Cushing's reflex--->Hypertension and bradycardia supsecting increased ICT.patient's reflexes are lost which suggest intracranial damage.If,only sensations were lost,we could have thought about spinal cord injury.
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| ssrpk
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B: Hypotension and bradycardia
it probably is spinal shock with loss of sympathetic stimulation
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| hanialkhadher
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B , Neurogenic shock due to loss of sympathetic tone and the dominance of vagal tone is not right , neutogenic shock occurs with T6 and above lesions to affect the cardiac output( Refer to any good text or eMedicine). So what looks a better answer is D .
Edited by hanialkhadher on 05/16/07 - 11:57 PM
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| ssrpk
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i agree with ur answer hanialkhader but since D is incorrect as mentioned by doyoudig, this seem likely although a reasonable explanation is reuired here
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| doyoudig
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the answer is BBBBB
Yes Neurogenic Shock which means , sympathetic tone is lost n norep will not be acting to incr BP. In Loss of Symp tone leads to Unopposed Parsymt tone hence the bradycardia
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| ssrpk
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but why would neurogenic shock occur with complete T10 lesion???
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| doyoudig
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Ur right friend , my mistake not neurogenic , spinal
anyone interedted can read up on it here
http://www.emedicine.com/pmr/byname/spinal-cord-i...
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| doyoudig
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here is the entire explanation may u can extend on that ssrpk
This patient has hypotension and bradycardia (choice B) as a result of neurogenic shock. Sympathetic outflow is absent after spinal cord injuries. As a result of sympathetic paralysis, norepinephrine cannot act on blood vessels to induce vasoconstriction; thus, hypotension follows. Failed sympathetic function leads to unopposed parasympathetic action, which causes bradycardia.
A variable degree of hypertension with tachycardia (choice A) is seen in patients with acute severe pain; relief of pain lowers blood pressure and heart rate. The combination of hypertension and bradycardia (choice C) signifies raised intracranial pressure, as occurs in epidural hemorrhage. Cerebral perfusion pressure, which should be 50 mm Hg at a minimum, depends on the difference between mean arterial pressure and cerebrospinal fluid (CSF) pressure. As intracranial pressure rises, CSF pressure rises; the difference between mean arterial pressure and CSF pressure falls. To maintain the minimum level of cerebral blood flow, the systolic blood pressure has to rise. Bradycardia is a consequence of the resulting hypertension. Hypotension and tachycardia (choice D) are seen in hypovolemic shock, in which there is loss of extracellular volume into the third space or elsewhere. In the case of spinal injuries, there is no loss of blood from within the vascular compartment. The blood remains within the system but cannot be distributed due to lack of sympathetic function; hence, there is bradycardia rather than the more typical tachycardia. Furthermore, the treatment of neurogenic shock involves use of vasoconstrictors to drive the blood back into circulation, while hemorrhagic shock requires volume expansion
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