Treatment for neurogenic shock

What is the treatment for neurogenic shock? 

In neurogenic shock, injury to the spinal cord results in decreased sympathetic input to the vascular system. Most of the patient’s blood supply is left in the venous or capacitance system. Fluid therapy is an appropriate initial treatment, but pressor agents may also be needed. Norepinephrine and phenylephrine are powerful α-agonists and are often recommended for neurogenic shock in the setting of normal heart rate and cardiac output. Due to its inotropic properties dopamine is an excellent alternative to norepinephrine and phenylephrine when cardiac output and heart rate are inadequate. If the patient has profound bradycardia, atropine may be used to increase the heart rate and, therefore, the cardiac output. 


Consortium for Spinal Cord Medicine: Early acute management in adults with spinal cord injury: A clinical practice guideline for health-care providers. Washington, DC, Paralyzed Veterans of America, 2008. Available from . Accessed August 6, 2013. 

Stevens RD, Bhardwaj A, Kirsch JR, Mirski MA: Critical care and perioperative management in traumatic spinal cord injury. J Neurosurg Anesthesiol 2003;15(3):21-29.


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