Page 170 - Critical Care Notes

4223_Tab05_141-174 29/08/14 8:28 AM Page 164

NEURO
■ Temperature change
■ Acute pain
■ Spasticity
■ DVT and pulmonary embolus
■ Pressure ulcers
■ Burns, blisters, sunburn, insect bites
■ Tight, constrictive clothes or shoes
■ Ingrown toenails
Management
■ Place patient in sitting position and monitor vital signs every 5 min.
■ Loosen constrictive clothing or devices.
■ If no indwelling catheter, palpate bladder for distention → insert Foley
catheter.
■ If indwelling catheter, check for kinks and obstruction and irrigate
if necessary.
■ Check for fecal impaction and administer laxative as needed. Use 2% lidocaine
jelly 10–15 min before removing impaction.
■ Assess skin for pressure or irritation.
■ If SBP >150 mm Hg, administer an antihypertensive such as nifedipine
(Procardia) sublingually and nitrates (nitroglycerine paste) as first line of
treatment. Consider hydralazine (Apresoline), mecamylamine (less com-
monly used), phenoxybenzamine (Dibenzyline), diazoxide (Hyperstat).
■ The sweating will become less profuse or stop.
■ There will usually be an immediate lowering of the BP, although it may
take about 1 hr for BP to decrease if BP is very high.
■ Fatal complications include pneumonia, renal failure, pulmonary embolism,
and septicemia.
Neurogenic Shock
Neurogenic shock generally occurs in SCIs above T6. It may develop in days or
months after the injury.
Neurogenic shock is caused by vasoconstriction and venous pooling (veins
dilated and filled with blood) →↓ BP, ↓ systemic vascular resistance, ↓ HR, ↓ CO,
↓ respiration rate →↓ blood flow to vital organs → organ damage and ischemia.
The patient may also have the inability to sweat below the level of injury
→ hypothermia.
Treatment involves the administration of vasopressors, atropine, and treat-
ment of hypothermia.

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