A patient is brought to the emergency department following a high-speed motor vehicle collision. The patient has a suspected cervical spinal cord injury. Which of the following sets of vital signs is most characteristic of neurogenic shock?
Hypertension and tachycardia
Hypertension and bradycardia
Hypotension and tachycardia
Hypotension and bradycardia
The correct answer is hypotension and bradycardia. Neurogenic shock results from the disruption of sympathetic nervous system pathways, commonly seen in spinal cord injuries at or above the T6 level. This leads to a loss of vascular tone, causing vasodilation and subsequent hypotension. Concurrently, the unopposed parasympathetic (vagal) stimulation to the heart results in bradycardia. Hypotension with tachycardia is the classic presentation for hypovolemic or septic shock. Hypertension with bradycardia is a component of Cushing's triad, indicating increased intracranial pressure. Hypertension and tachycardia can be seen with other injuries or pain but are not indicative of neurogenic shock.
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