Advanced Medical Life Support (AMLS)

What type of shock is indicated by a bradycardic, hypotensive patient with warm, dry skin after thoracic spine surgery?

1. Hypovolemic

2. Obstructive

3. Cardiogenic

4. Neurogenic

The correct answer is: Neurogenic

In the scenario described, a bradycardic, hypotensive patient with warm, dry skin after thoracic spine surgery is indicative of neurogenic shock. This type of shock occurs due to the disruption of sympathetic nervous system control, typically following a spinal cord injury or significant spine surgery, leading to a loss of vascular tone. In neurogenic shock, the body's ability to regulate blood vessel constriction is impaired, which results in dilated blood vessels. This vasodilation causes blood pooling, leading to reduced venous return to the heart and subsequent hypotension. Despite the low blood pressure, the warm, dry skin is characteristic; since there is less sympathetic tone, the blood vessels remain dilated rather than constricting as they would in other forms of shock, which often present with cold and clammy skin. Bradycardia associated with hypotension in this case suggests that the heart is not compensating effectively, which aligns with the autonomic dysregulation seen in neurogenic shock. In other types of shock, such as hypovolemic or cardiogenic, compensatory mechanisms would typically produce tachycardia (increased heart rate) rather than bradycardia. Thus, the warm skin, the bradycardia,