NREMT Paramedic Cognitive ExamTraumaMedium
A 25-year-old male is suspected of having a spinal cord injury after a diving accident. He is conscious and alert but complains of tingling in both hands and feet. His blood pressure is 100/70 mmHg, heart rate is 60 bpm, and skin is warm and dry below the neck. These findings are most consistent with which type of shock?
- ANeurogenic shock
- BAnaphylactic shock
- CCardiogenic shock
- DHypovolemic shock
Show answer & explanationAnswer & explanation
Correct answer: A. Neurogenic shock
The patient's presentation of hypotension, bradycardia, and warm, dry skin below the level of injury in the context of a suspected spinal cord injury (especially with neurological deficits like tingling) is classic for neurogenic shock. This occurs due to loss of sympathetic tone.
Why the other options are wrong
- B. Anaphylactic shock presents with hypotension, tachycardia, bronchospasm, and urticaria/angioedema, which are not seen here.
- C. Cardiogenic shock typically presents with hypotension, tachycardia, and signs of pulmonary congestion (e.g., crackles), not bradycardia and warm, dry skin.
- D. Hypovolemic shock presents with hypotension and tachycardia (not bradycardia), and cool, clammy skin.
Neurogenic Shock
A type of distributive shock caused by a severe spinal cord injury (typically above T6) that results in loss of sympathetic nervous system tone, leading to widespread vasodilation, hypotension, and bradycardia.
- Characterized by hypotension, bradycardia, and warm, dry skin.
- Distinguish from spinal shock (which is a temporary loss of function, not a circulatory shock).
- Requires fluid resuscitation and often vasopressors to increase blood pressure.
Memory trick: Shock Says: Hypo=Fast, Neuro=Slow, Anaphy=Hives, Cardio=Wet