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 and is characterized by hypotension, low heart rate, and well perfused extremities. Hypovolemic shock should be suspected with polytrauma and abdominal, pelvic, or severe orthopedic injuries. Hypovolemic shock is associated with hypotension, rapid heart rate, and cool extremities.
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 levophed) infusion should be initiated. Hypovolemic shock should be treated as per usual protocol with appropriate volume resuscitation.
If irregularities are observed, an infusion should be prepared and external bleeding is stopped, if present. In some cases, medication to increase blood pressure or heart beat has to be used.
If cardiovascular status is adequate, see next step.