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Emergency Medicine

Answer 3
  1. Hypovolemic shock. Hemorrhage is by far the leading trigger of shock in trauma patients. Despite apparent signs of a spinal cord transection in this patient, primary management of shock is aimed at correction of hypovolemia.5 Additionally, hypovolemia may coexist with a spinal cord injury. It is much safer to treat shock presumptively as hypovolemic shock first, because premature use of vasopressors exacerbates ischemia and subsequent morbidity and mortality.6 Neurogenic shock is the loss of vascular tone that occurs when the sympathetic nervous system is interrupted by a high-level spinal cord injury, causing peripheral venous pooling and subsequent hypotension. Spinal shock is a temporary loss of tone and spinal reflexes below the level of the injury. A trauma patientıs symptoms should never be attributed to alcohol or drug use until other etiologies are excluded.5

     American College of Surgeons. Advanced Trauma Life Support course instructor’s manual. 6th ed. Chicago: The College; 1997.

    6. Peitzman AB, Billiar TR, Harbrecht BG, et al. Hemorrhagic shock. Curr Probl Surg 1995;32:925-1002.

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