Neurogenic shock in patients with spinal cord injuries can be fatal. Catecholamines are commonly used for the management of neurogenic shock; however, the treatment of catecholamine-refractory neurogenic shock remains challenging. A 78-year-old woman with neurogenic shock from cervical cord injury underwent posterior cervical spine decompression and fixation. The patient's blood pressure could not be maintained with catecholamine administration throughout the surgery. Therefore, indigo carmine was administered, and an effective increase in blood pressure was achieved. The postoperative course was uneventful. The findings from this case indicate that indigo carmine may have an effective vasoconstrictive action in patients with neurogenic shock who do not respond to catecholamines.
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http://dx.doi.org/10.7759/cureus.41004 | DOI Listing |
Prehosp Emerg Care
December 2024
Department of Emergency Medicine, North Memorial Health Level I Trauma Center, Minneapolis, Minnesota.
Acutely injured trauma patients may develop shock from several potential mechanisms, including hypovolemic shock from hemorrhage, neurogenic shock from traumatic brain injury (TBI) or spinal cord injury, obstructive shock from tension pneumothorax or pericardial tamponade, or a mix of several of these mechanisms. Regardless of the cause, restoration of adequate perfusion is of critical importance to reduce the morbidity and mortality of trauma patients with shock. Multiple interventions including hemorrhage control, volume resuscitation with intravenous fluids or blood products, and pleural decompression procedures are used to address some of these issues and are discussed elsewhere in the trauma compendium.
View Article and Find Full Text PDFGland Surg
November 2024
Oncology Center, Sírio-Libanês Hospital, São Paulo, Brazil.
Background: Surgical resection of locally advanced or borderline pancreatic ductal adenocarcinoma is a recognized procedure with curative intent performed in specialized oncology centers. Postoperative dysautonomia such as gastroparesis, mild hypotension, and diarrhea are common in elderly patients undergoing pancreaticoduodenectomy. A distinctive feature of our case, is the severing of an important sympathetic chain by the surgical procedure, leading to recurrent severe neurogenic shock.
View Article and Find Full Text PDFAnn Med Surg (Lond)
November 2024
Gynagologist Damascus University, Faculty of Medicine, Gynagology and Obstetric Department, Damascus, Damascus Governorate, Syria.
Cureus
October 2024
Department of Anesthesiology and Perioperative Care, University of California Irvine Health, Orange, USA.
Gunshot wounds (GSWs) to the head and neck are a common etiology of traumatic brain injury. Tangential GSWs (TGSWs) are a subset of GSWs wherein the missile penetrates tissue adjacent to the cranium, causing varying degrees of intracranial injury. Most patients sustaining TGSWs present with relatively benign neurological findings, and while a significant proportion have varying degrees of intracranial hemorrhage (ICH) on computed tomography, these tend to respond well to nonoperative management.
View Article and Find Full Text PDFNeurourol Urodyn
October 2024
Department of Urology, University of Bristol, Bristol, UK.
Introduction: Defining "high-risk bladder" or "high-pressure bladder" involves recognizing the potential for an unsafe lower urinary tract, where dysfunction in storage and micturition can threaten upper urinary tract health, leading to unfavorable outcomes like dialysis, recurrent infections, systemic impact, or mortality.
Methods: ICI-RS was held in Bristol in June 2024, and Think Tank 2 aimed to define research priorities including identifying clinical predictors and developing prevention and monitoring strategies.
Results: Risk factors encompass both congenital and neurogenic lower urinary tract dysfunction, bladder outlet obstruction, vascular diseases, and inflammatory disorders, but a validated stratification risk is lacking.
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