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Neurogenic shock — DipIMC MCQ

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ModerateTraumaNeurogenic shockDipIMC

A 23-year-old diver hit his head in shallow water. He is hypotensive with warm peripheries, bradycardia, priapism and bilateral leg weakness. What is the most appropriate immediate action?

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Correct answer: C — Treat as high spinal cord injury with immobilisation, oxygenation and cautious circulatory support

Treat as high spinal cord injury with immobilisation, oxygenation and cautious circulatory support is the best answer because bradycardic hypotension with neurological deficit after spinal trauma suggests neurogenic shock. Give a large crystalloid bolus before controlling the injury is less appropriate because fluid cannot replace early control of bleeding or ventilation problems; Perform a full secondary survey before treating the abnormality is less appropriate because secondary survey follows correction of immediate life threats. Wait for imaging before intervening and Transport without treating the identified time-critical problem are also suboptimal because they move attention away from the key pre-hospital priority.. The key DipIMC principle is to treat immediate reversible threats, communicate clearly and move the patient toward the right definitive care.

Reference: JRCALC Guidelines; NICE Major Trauma NG39