The Infamous MCQ about Neurogenic Shock

#1

A 36-year-old man is rushed into the emergency department by paramedics after he sustained a head-on collision as an unrestrained driver. He has a hard collar and his head is fixed to a spine board. On a quick review, he is conscious and fully oriented, but in distress as he is not able to feel his arms and legs. There is no visible site of active bleeding, nor is there limb deformity. Chest is clear to auscultation, neck veins are not raised, and abdominal exam is inconclusive. His blood pressure is 90/40mmHg, heart rate 50bpm and respiratory rate 18 breath per minute. His oxygen saturation is 88% on room air. Sphincter tone is decreased and there is no sensation or deep tendon reflexes from neck down. Which one of the following would be the most appropriate next step in management?

1. Placement in Trendelenburg position.
2. Intravenous colloid fluids.
3. Blood transfusion.
4. Adrenaline.
5. Atropine.

#2

A 30-year-old woman is brought into the emergency department after a falling from her horse during horse ride. She has a hard collar on and her head is taped to a hard spine board. She is fully conscious and oriented but unable to move any of her limbs. She answers the question in a normal voice. On a quick review, no visible active bleeding is noted. Chest is clear to auscultation and abdominal exam is inconclusive. No limb deformity is noted either. She has a blood pressure of 85/40mmHg, heart rate of 50bpm, and oxygen saturation of 90% on room air. Which one of the following is the most appropriate next step in management?

1. Atropine.
2. Adrenaline.
3. Trendelenburg position.
4. Oxygen.
5. Intravenous colloid fluids.