John Jackson has suffered a spinal cord injury after a motorcycle accident and i

Question

John Jackson has suffered a spinal cord injury after a motorcycle accident and is in neurogenic shock. Explain how John can be in shock when he has lost no fluid from vasculature?

Analyze the importance of meticulous wound management, adequate fluids and nutrition, and early excision and grafting in survival of a major burn injury and alleviation of side effects?

What are some of the clinical indicators of MODS you would monitor in a young child? Include manifestations affecting each of the following systems: CNS, renal, pulmonary, cardiovascular, hepatobiliary?

Explanation / Answer

1. Neurogenic shock is a type of distributive shock resulting in low blood pressure which is caused due to disruption of autonomic pathways within the spinal cord. Low blood pressure is not caused due to loss of fluid or blood but due to decreased systemic vascular resistance . This can result in pooling of blood within the extremities too. So even though John didn't lose fluid because of his spinal cord injury he can have neurogenic shock.

2. Burn wound management is very important because

a) burns are the worst trauma which when not treated properly can cause death.

b) It can lead to serious infections and septic shock causing death.

c) Cleaning of wounds regularly should be a proper practice to avoid infestation of bacteria and further complications.

3) MODS is multiorgan dysfunction syndrome and causes two or more organs to dysfunction. Clinical indicators of MODS in a child may be high fever,racing heart,labored breathing ,colour changes. Manifestations affecting

CNS - subclinical edema and reduced cerebral perfusion pressure.

Renal - rising creatinine level, impairment in excretory function, reduced renal blood flow.

Pulmonary - failure to normal gas exchange, arterial hypoxemia

Cardiovascular- myocardial depression, diffuse capillary leak and edema, reduction in peripheral vascular tone.

Hepatobiliary - gastrointestinal bleeding,ulceration,bloating,diarrhoea,gut dysfunction.

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