Bradycardia and hypotension following trauma to the spine indicate which condition?

• A. Hypovolemic shock
• B. Cardiogenic shock
• C. Neurogenic shock
• D. Anaphylactic shock

Answer: (C)

Neurogenic shock occurs when spinal injury disrupts sympathetic outflow, leading to loss of vasomotor tone below the injury and unopposed parasympathetic (vagal) influence. This combination causes low systemic vascular resistance (vasodilation) and bradycardia, producing hypotension. In the trauma setting, bradycardia with hypotension after a spinal injury is a classic sign of neurogenic shock, because the heart loses sympathetic stimulation that would normally speed its rate and maintain vascular tone.

This pattern helps distinguish it from other shock types. Hypovolemic shock from blood loss typically shows tachycardia and cool, clammy skin due to poor perfusion. Cardiogenic shock also tends to present with tachycardia and signs of heart failure, rather than pure bradycardia from loss of autonomic input. Anaphylactic shock usually presents with hypotension plus tachycardia and allergic symptoms. In neurogenic shock, skin is often warm due to vasodilation, and the key clue is the bradycardia paired with hypotension after a spinal injury.

Management focuses on stabilizing the spine, securing the airway, and restoring vascular tone with vasopressors (and atropine if the bradycardia is symptomatic), while guiding cautious fluid resuscitation and close monitoring.