Neurogenic Shock Cardiovascular Profile — FRCA Final MCQ

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EasyTrauma & Emergency AnaesthesiaNeurogenic Shock Cardiovascular ProfileFRCA Final

A 40-year-old man involved in a motorcycle accident has an unstable C4/5 fracture-dislocation with a complete spinal cord injury at C4. He is being ventilated in ICU. What is the expected autonomic cardiovascular profile in the acute phase?

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Correct answer: A — Hypertension and tachycardia

A complete cervical spinal cord injury at C4 disrupts sympathetic outflow from the thoracolumbar cord (T1-L2) while parasympathetic supply to the heart (vagus nerve, arising above the injury) remains intact. This produces: loss of sympathetic vasomotor tone below the lesion (vasodilation, hypotension, warm peripheries), loss of cardiac sympathetic innervation (T1-T4), and unopposed vagal tone (bradycardia). This combination of hypotension and bradycardia is neurogenic shock. Treatment: IV fluids, vasopressors (noradrenaline preferred for combined alpha and beta effects), and atropine for symptomatic bradycardia.

Reference: NICE – 2016 – NG41 Spinal injury; ATLS – 2018 – 10th edition