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  • • Head injury

    • Increased intracranial pressure

    • Caused by pooling of blood in denervated autonomic venules and small veins

    • Usually due to spinal cord injury

    • Not caused by isolated head injury

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Epidemiology

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  • • Post-traumatic

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Symptoms and Signs

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  • • Hypotension after trauma

    • Warm extremities—sometimes with hyperemia

    No other evident causes of shock, such as hypovolemic or cardiogenic

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  • • Hypovolemic shock

    • Cardiogenic shock

    • Septic shock

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  • • Therapeutic test: Trendelenburg followed by 2 L IV fluid bolus

    • If shock persists, consider phenylephrine infusion and other causes

    • Radiographic evaluation of spinal column

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  • • Supportive care of blood pressure to maintain perfusion

    • Stabilize and protect spine from further injury

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References

Kress JP et al: Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000;342:1471.  [PubMed: 10816184]
MacIntyre NR et al: Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001;120(6 Suppl):375S.

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