Neurogenic shock is a shock state resulting from loss of sympathetic tone, causing relative hypovolemia.

Sympathetic stimulation causes vascular smooth muscle to constrict, and parasympathetic stimulation causes vascular smooth muscle to relax or dilate. Vasodilation occurs as a result of a loss of balance between parasympathetic and sympathetic stimulation. The overriding parasympathetic stimulation that occurs with neurogenic shock causes a drastic decrease in the patient's systemic vascular resistance and bradycardia. Inadequate BP, despite an adequate blood volume, results in the insufficient perfusion of tissues and cells that is common to all shock states.

Quality and Safety Nursing Alert

Symptoms are consistent with signs of parasympathetic stimulation:

• Dry, warm skin
• Bradycardia

• Restore sympathetic tone (e.g., stabilizing spinal injury or repositioning patient with spinal anesthesia).
• Specific treatment depends on the cause of the shock.

• Elevate head of the bed at least 30 degrees for spinal or epidural anesthesia.
• Immobilize patient if spinal cord injury is suspected to prevent further damage.
• Assess for lower-extremity pain, redness, tenderness, or warmth that may suggest formation of a venous thromboembolism.
• Provide passive range of motion to promote circulation.
• Use pneumatic compression devices combined with antithrombotic agents (e.g., low-molecular-weight heparin).
• Assess for signs of internal bleeding.

For more information, see Chapter 14 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.