Neurogenic shock may be encountered in trauma patients with injury to the cervical and upper thoracic spinal cord. It occurs due to the sudden loss of vasomotor tone after sympathetic denervation, with vasodilatation and expansion of the intravascular volume.



(1) hypotension with weakly palpable peripheral pulses

(2) usually bradycardia, sometimes normal pulses, and uncommonly tachycardia

(3) extremities appear warm and perfused, with pink nail beds and good capillary refill

(4) traumatic injury with (a) cervical or upper thoracic vertebral fracture, (b) epidural hematoma, (c) other trauma to spinal cord

(5) sensory or motor deficit consistent with spinal cord injury

(6) persists after correction of volume depletion, but may respond to volume expansion with crystalloid

(7) may reverse in 24-48 hours after the injury

(8) with inadequate perfusion metabolic acidosis occurs with elevated serum lactic acid levels



(1) Need to carefully exclude hemorrhagic shock, especially occult intra-abdominal hemorrhage.

(2) Excessive fluid infusion can cause pulmonary edema.


Findings indicative of adequate perfusion:

(1) clear sensorium

(2) good urine output

(3) absence of a base deficit


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