The patient should be hooked up to a cardiac monitor. An arterial line should be established to monitor blood pressure and to obtain arterial blood gases.
With a spinal cord injury it is critical to maintain the mean arterial blood pressure over 85 mm Hg. It is important to distinguish neurogenic from hypovolemic shock.
Neurogenic shock occurs with a severe cervical or high thoracic spinal cord injury.
Hypovolemic shock is more common than Neurogenic shock even in spinal cord injuries and should be suspected with polytrauma and abdominal, pelvic, or severe orthopedic injuries.
Neurogenic and hypovolemic shock can coexist.
In the hypotensive patient these two types of shock are primarily distinguished by the presence of bradycardia in neurogenic shock and tachycardia in hypovolemic shock. Another distinction includes well perfused extremities in neurogenic shock and cool extremities in hypovolemic shock.
Neurogenic shock should be treated with an initial bolus of 1L of crystalloid or colloid solution. Following this, if hypotension persists, an inotrope (dopamine or norepinephrine) infusion should be initiated. Hypovolemic shock should be treated as per usual protocol with appropriate volume resuscitation.
The presence of hemodynamic instability requires a comprehensive evaluation to detect and treat areas of potential hemorrhage, provide fluid resuscitation, and appropriate medications to optimize blood pressure or heart rate.
If cardiovascular status is adequate, see next step.