A 45 year old male is brought in by ambulance after falling from tree. He is able to talk but unable to move his extremities. He has recieved 2 liters of fluid enroute for hypotension. His most recent vital signs show: pulse 80, BP 75/50, RR 20, 36.5°C, O2 sat 97% on 2 liters via NC. While doing your FAST exam, you see an IVC which does not change with respiration. What is the most appropriate next step?
This patient has neurogenic shock from a cervical spinal injury, resulting in hypotension from lack of sympathetics.
He doesn't need fluids at the time because the "tank is full," indicated by a non-collapsing IVC upon respiration.
He will need a surgical intervention, so neurosurgery will be recommended.
IV steroids are controversial in spinal injuries.
Thus, the most appropirate next step is to start pressors for his hypotension from spinal shock
Clinical Bottom Line: Use the ultrasound to evaluate fluid status in patients with shock. Spinal shock may show hypotension and normal heart rate. Start pressors for spinal shock if patient is adequately fluid resuscitated.