Question

A hiker fell 25 feet from a ledge. There is obvious deformity to his thoracic spine and he has a large laceration on his forehead. His BP is 60/40 mm Hg, pulse is 50 beats/min, and respirations are 26 breaths/min. His face and chest are pale and cool, but his abdomen and lower extremities are pink and warm. Which of the following BEST describes the pathophysiology of these findings?

a) Neurogenic shock
b) Hemorrhagic shock
c) Cardiogenic shock
d) Distributive shock

Answer 1

The hiker with a thoracic spinal injury and signs of hypotension and bradycardia is likely experiencing neurogenic shock, a type of vascular shock associated with spinal injuries.

Step-by-step explanation:

The clinical presentation described in the question suggests that the hiker is experiencing neurogenic shock, which is a type of vascular shock that occurs with cranial or high spinal injuries that damage the cardiovascular centers in the medulla oblongata or the nervous fibers originating from this region. Neurogenic shock typically results in hypotension (as evidenced by a blood pressure of 60/40 mm Hg) and bradycardia (heartbeat of 50 beats/min), which matches the patient's symptoms. Despite obvious trauma and low blood pressure, the distinct lack of tachycardia (an increased heart rate) and the presence of warm pink skin in the abdomen and lower extremities are characteristic of neurogenic shock, where vasodilation occurs due to loss of sympathetic tone, not necessarily due to blood volume loss as seen in hemorrhagic or hypovolemic shock.