A 28-year-old man sustains a complete cervical spinal cord transection at C6 in a fall. On arrival he has BP 82/48 mmHg, HR 46 bpm, warm dry peripheries, and flaccid paralysis below the level of injury. Which is the most appropriate initial vasopressor?
- A Phenylephrine
- B Norepinephrine ✓
- C Adrenaline infusion
- D Isoprenaline
Correct answer: B. Norepinephrine
Explanation
Neurogenic shock results from loss of sympathetic outflow, producing hypotension with bradycardia and loss of vascular tone. Norepinephrine provides alpha-mediated vasoconstriction plus some beta-1 chronotropy, correcting both the low pressure and the bradycardia, and is the recommended agent in spinal cord injury guidelines. Pure alpha agents such as phenylephrine can worsen the bradycardia, which kills that distractor.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.