Spinal shock refers to a clinical syndrome associated with the loss of autonomic tone leading to hypothermia, hypothermia, and ileus below the level of spinal cord injury. It is characterized by loss of sensory and motor functions and loss of reflexes. When does it happen? All the patients who have to undergo the surgeries below the abdomen must have taken spinal anesthesia. Spinal anesthesia is given at the level of L3-L4, (at the midpoint of two anterior iliac spines).
Bupivacaine is used in spinal anesthesia to block the nerve and decrease the feeling in that area. It is injected in the subdural space around the nerve. The main purpose of spinal is to numb the area of your body during and after the surgery. It can be given at sitting position or lateral position depending on the type of surgery. The most preferable position is sitting.
How Will You Diagnosed Your Patient Have Spinal Shock?
When the spinal is given in a sitting position, the patient looks vitally stable. Spinal shock develops suddenly within a few minutes or hours.
Sudden, temporary loss of sensory and motor functions below the level of spinal cord injury is referred to as a spinal shock. It is characterized by decreased blood pressure, increases sweating, nausea, etc. It shows the patient is going in a shocking state.
Signs & Symptoms of Spinal Shock
Signs and symptoms after spinal cord injury depend on the position of injury along with the spinal cord and the severity of the spinal injury.
Emergency signs and symptoms of spinal shock after spinal cord injury include
Weakness and paralysis in any part of your body below the level of L3-L4 level.
Numbness, loss of sensation, and tingling in your hands, face, toes, or feet.
- Decrease blood pressure
- Increase sweating or hypothermia
- Loss of bowel and bladder control
- Loss or altered speech
- Loss of ability to differentiate the hot and cold touch
- Nausea with or without vomiting
- Extreme backache or pressure in your neck
- Decrease cardiac output or heart rate
- Paralysis of skeletal and smooth muscles
These emergency symptoms should be managed as soon as possible to prevent permanent loss.
Difference Between Spinal Shock And Neurogenic Shock?
The ‘shock’ in spinal shock does not refer to circulatory collapse and doesn’t confuse it with the neurogenic shock, which is a life-threatening condition.
Neurogenic Shock: It refers to hemodynamic changes resulting in loss of reflex and loss of autonomic tone after the spinal cord injury. Whereas the loss of sensation after the spinal cord injury is referred to as Spinal Shock. The anesthetic should keep monitoring the patient’s vitals and facial expressions to promptly diagnosed the symptoms of spinal shock. Keep talking patient and keep waking the patient.
Your health care provider will perform a lot of tests to differentiate the spinal shock and neurogenic shock.
Common Causes of Spinal Shock
Other than spinal anesthesia, the most common causes of spinal cord injuries are
History of Fall
After the age of 65, the most common cause of spinal cord injury is fall.
Motor vehicles and bikes are the most common leading cause of spinal cord injury.
- Sports injuries
- Disc prolapse
- Some diseases like cancers, arthritis, and osteoporosis, etc.
Management of Spinal Shock
Unfortunately, there is no specific treatment to treat the damaged nerve but researches are being made to regenerate the damaged nerve by some medicine or prostheses. But some important emergency steps should be taken as soon as possible.
Airway and breathing
If the patient is unable to breathe or the patient is feeling difficulty in breathing then secure the airway immediately. Attached the oxygen through a facemask. Lack of oxygen in the blood may cause hypoxemia resulting in brain death. Therefore, airway and breathing should be managed in all the patient of spinal shock.
Now monitor the blood pressure and pulse of the patient. Patients of shock have unrecordable blood pressure and impalpable pulse ( BPless or pulseless) due to pooling of blood and the decrease in cardiac activity. So, your health care team should start fluids in rush along with the triple support ( dobutamine, dopamine, and morphine) to maintain the blood pressure, heart rate, and cardiac activity.
Immobilized the patient’s neck to prevent further spinal cord damage at the level of the neck. Use neck collars to secure the neck. Sometimes traction may be needed to realign and stabilize the spinal cord. Sometimes special rigid bed may also help secure the spinal cord.
Antibiotics are given prophylactically in all the patients against the gram-negative, gram-positive, and anaerobic bacteria to prevent or treat sepsis.
The final and last solution is surgery to remove the fragments, fractured parts of the bone or foreign objects.
This treatment is symptomatic. There is no proper medication to treat or regenerate the damaged portion of the spinal cord. Spinal cord injury is an irreversible loss. Though immediate intervention can prevent further complications of spinal injury like permanent loss of bladder and bowel control, muscle tone, pain, sexual health, and depression.