Neurogenic shock
Summary
Distributive shock caused by loss of sympathetic tone, classically after high spinal cord injury (above T6). Presents with hypotension and paradoxical bradycardia plus warm, dry, flushed skin.
Detail
Disruption of descending sympathetic pathways causes loss of vasomotor tone (vasodilation, decreased SVR) and unopposed vagal tone to the heart (bradycardia), distinguishing it from hypovolemic and septic shock, which feature compensatory tachycardia. The skin is warm and dry because cutaneous vasoconstriction and sweating (sympathetic) are abolished. Contrast with spinal shock, which is a transient flaccid areflexia after cord injury and is not a hemodynamic shock state. Management: IV fluids, vasopressors (norepinephrine or phenylephrine) to restore tone, and atropine or chronotropic support for symptomatic bradycardia, alongside spinal stabilization. High-yield clue: trauma patient with hypotension and bradycardia rather than tachycardia.
Sources
- First Aid for USMLE Step 2 CK
- Harrison's Principles of Internal Medicine
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