A 24-year-old man falls from height. He has BP 82/50 mmHg, heart rate 46/min, warm dry skin, and flaccid paralysis with absent reflexes below the nipple line. Two litres of crystalloid produce no rise in blood pressure. What is the next best step?

• A Continue aggressive crystalloid boluses
• B Start norepinephrine infusion ✓
• C Give intravenous atropine alone
• D Start epinephrine infusion

Explanation

The combination of hypotension with paradoxical bradycardia, warm skin, and a sensory-motor level points to neurogenic shock from cervical or upper thoracic cord injury. Loss of sympathetic vasomotor tone requires a vasopressor with alpha activity; norepinephrine restores vascular tone and supports chronotropy. Atropine treats isolated bradycardia but does not correct the peripheral vasodilation driving the hypotension.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.