Circulatory instability

• So-called 'spinal shock' may occur with marked hypotension due to sympathetic outflow disturbance. Hypovolaemia should be excluded first. Consider damage to other organs/vessels, e.g. spleen, aorta.

• Vasopressor therapy may be necessary if evidence of tissue hypoperfusion persists, e.g. oliguria, metabolic acidosis.

• Postural hypotension and circulatory instability (including symptomatic bradycardia) is commonplace for the first few weeks. Autonomic dysfunction affects 50% of cervical and high thoracic cord injuries.

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