Cardiovascular considerations in the critical care phase.

Spinal shock results in impaired cardiovascular reflexes of those persons with spinal cord injury above T6. This population can be at high risk for cardiovascular instability. Sympathetic pathways are interrupted and the result is uninhibited vagal tone and vascular atony. The spinal shock victim presents with hypotension, hypothermia, and bradycardia. Hypovolemia, hypoxia, and further temperature decreases can precipitate instability. Overhydration can lead to pulmonary edema and extended injury. The goal of therapy is to optimize perfusion with positioning, careful fluid replacement, and pharmacologic agents as needed. Cardiac rhythm disturbances are common and can be potentiated by hypoxia, endotracheal suctioning, hypothermia, and position changes. The goal of treatment is to avoid the offending event and to pretreat anticipated bradydysrhythmias with atropine. Close monitoring of cardiac and respiratory status is a minimum requirement for such patients. Within the high risk group exists a subgroup who demonstrate a high degree of cardiovascular instability. This group has a high mortality rate. Identification of patients who may require prolonged monitoring or more aggressive therapies may assist in eventual positive outcomes.