A 32-year-old man is brought after a fall from height. He has a cervical spine injury with hypotension (BP 85/55 mmHg) and bradycardia (HR 52/min). The skin is warm and dry. Which type of shock is this, and what is the primary physiological mechanism?

• A Hypovolemic shock from occult internal hemorrhage
• B Septic shock from wound contamination
• C Obstructive shock from tension pneumothorax
• D Neurogenic shock due to loss of sympathetic vascular tone ✓

Explanation

Neurogenic shock results from cervical or high thoracic spinal cord injury causing loss of sympathetic vascular tone, leading to vasodilation and hypotension. The hallmark is bradycardia (unopposed vagal tone) rather than the tachycardia seen in hypovolemic shock. Warm, dry skin reflects peripheral vasodilation. This distinguishes it from hemorrhagic shock where tachycardia and cold clammy skin predominate. Treatment includes fluids and vasopressors.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.