Which is part of the initial management for suspected neurogenic shock?

• A. Keep patient supine and reduce movement
• B. Elevate head of bed
• C. Administer diuretics
• D. Begin immediate vasopressor therapy with norepinephrine

Answer: (A)

Neurogenic shock occurs when spinal cord injury disrupts sympathetic outflow, causing widespread vasodilation and hypotension (sometimes with bradycardia). The first step in management is to protect the spinal cord and support perfusion. Keeping the patient supine and minimizing movement helps maximize venous return to the heart, supporting preload and blood pressure without risking further injury to the spine during movement or transfers. Elevating the head of the bed would reduce venous return and worsen hypotension at this stage, so it isn’t appropriate as an initial maneuver. Administering diuretics would further deplete intravascular volume and worsen shock, so that’s not suitable early either. While vasopressors like norepinephrine are important if hypotension persists, they’re part of subsequent stabilization after ensuring spinal protection and initial volume assessment. The focus at this moment is on maintaining a flat, still position to optimize perfusion and minimize additional spinal damage.