Hemorrhage is by far the leading trigger of
shock in trauma patients. Despite apparent signs of a spinal cord
transection in this patient, primary management of shock is aimed at
correction of hypovolemia.5 Additionally, hypovolemia may coexist with
a spinal cord injury. It is much safer to treat shock presumptively as
hypovolemic shock first, because premature use of vasopressors
exacerbates ischemia and subsequent morbidity and mortality.6
Neurogenic shock is the loss of vascular tone that occurs when the
sympathetic nervous system is interrupted by a high-level spinal cord
injury, causing peripheral venous pooling and subsequent hypotension.
Spinal shock is a temporary loss of tone and spinal reflexes below the
level of the injury. A trauma patientıs symptoms should never be
attributed to alcohol or drug use until other etiologies are
- Hypovolemic shock.
5. American College of Surgeons. Advanced Trauma Life
Support course instructors manual. 6th ed. Chicago: The College;
6. Peitzman AB, Billiar TR, Harbrecht BG, et al. Hemorrhagic
shock. Curr Probl Surg 1995;32:925-1002.
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