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Sympa- thetic denervation stemming from brainstem or spinal cord injury (SCI) may also contribute to reductions in venous return due to increased vasodilation and peripheral venous pooling.22
In up to 5% of all major trauma cases, the spinal cord is injured and about 14% of these patients suffer from an unsta- ble spine injury.133 The American Spinal Injury Association (ASIA) has classified SCI into five categories, where ASIA A represents a complete impairment and ASIA E represents normal sensation and motor function (Table 84.10).
Sur- gical decompression of the spinal cord should be performed within 24 hours after SCI and is associated with improved neurologic outcome.134,135
Damage to the sympathetic outflow to the heart and vasculature after SCI contributes to systemic hypotension and bradycardia due to unopposed vagal tone, commonly referred to as neurogenic shock.136 Injuries above T7 have an 85% risk of serious cardiovascular instability.137 To avoid secondary injury after SCI, the MAP should be kept above 85 to 90 mm Hg during the first 7 days after injury using fluid and vasopressor therapy.138,139 Fluid ther- apy should be monitored by cardiac output monitoring devices and hypotonic solutions like dextrose 5% in water, Ringer´s lactate, and 0.45% sodium chloride should be avoided, as they worsen cord edema.
With complete cervical SCI, acute respiratory failure is common, secondary to the sudden loss of functional resid- ual capacity and the inability of the sternocleidomastoid muscle to stabilize the chest wall.
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