A 30-year-old man falls from height and sustains a complete spinal cord injury at the T6 level. On arrival he has BP 82/50 mmHg, HR 48/min, warm and dry peripheries, and flaccid paralysis below the nipple line. FAST scan and chest X-ray are unremarkable. Which is the most appropriate next step?

• A Start norepinephrine infusion to restore vascular tone ✓
• B Rapid infusion of 2 litres of crystalloid followed by packed red cells
• C Administer high dose methylprednisolone within 8 hours
• D Perform diagnostic peritoneal lavage to exclude occult bleeding

Explanation

Loss of sympathetic outflow below T6 causes neurogenic shock: hypotension with bradycardia and warm skin, distinguishing it from hemorrhagic shock where tachycardia and cool clammy skin dominate. After excluding hemorrhage, the treatment is vasopressor support, typically norepinephrine, which restores both vascular tone and heart rate. High dose steroids are no longer recommended in routine spinal cord injury. Fluid boluses alone will not correct the loss of vasomotor tone and risk overload.

Reference: ATLS Student Course Manual, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.