Three main teaching points discussed at noon report today are the following:
1. Illness script for neurogenic shock in someone with a high spinal cord lesion: Hypotension, bradycardia, spinal shock (paralysis without reflexes), and respiratory failure (likely due to diaphragmatic weakness/paralaysis).
2. Hand Drop Test: Consists of lifting a patient's hand over their face and dropping it. This helps providers evaluate for consciousness, pseudocoma, or pseudo-neurogenic conditions like paralysis. Sensitivity and specificity is not clear... I imagine that getting that study approved may prove difficulty. Hoover's Sign (feeling for synergistic contraction of the affected leg) is another exam maneuver to help differentiate organic vs inorganic paralysis which does not conceivably cause harm.
3. The alpha/beta spectrum of vasoactive agents are as follows:
Alpha <----- Phenylephrine, Norepinephrine, Epinephrine, Dobutamine, Isoproterenol---->Beta
Low doses - Dopamine
Medium doses - Beta
High doses - Alpha