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Spinal Cord Injury and Neurogenic Shock

EMS providers must be able to recognize and treat shock in patients with spinal cord injury before it causes further damage.  The objectives include to identify patterns of neurological deficits in spinal cord injury, describe the management of spinal cord injury, recognize neurogenic shock and describe the pathophysiology and management of neurogenic shock.


  • Identify patterns of neurological deficits in spinal cord injury
  • Describe the management of spinal cord injury
  • Recognize neurogenic shock
  • Describe the pathophysiology and management of neurogenic shock


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2. Devivo MJ. Epidemiology of traumatic spinal cord injury: Trends and future implications. Spinal Cord, 2012 May; 50(5): 365–72.

3. Ropper AE, Neal MT, Theodore N. Acute management of traumatic cervical spinal cord injury. Pract Neurol, 2015 Aug; 15(4): 266–72.

4. Hansebout RR, Kachur E. Acute traumatic spinal cord injury. UpToDate,

5. Theodore N, Hadley MN, Aarabi B, et al. Prehospital cervical spine immobilization after trauma. Neurosurgery, 2013 Mar; 72 Suppl 2: 22–34.

6. Haut ER, Kalish BT, Efron DT, et al. Spine immobilization in penetrating trauma: More harm than good? J Trauma, 2010 Jan; 68(1): 115–20.

7. Sekhon LH, Fahlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine (Phila Pa 1976), 2001 Dec 15; 26(24 Suppl): S2–12.

8. Currier BL, Coblyn J. Cervical subluxation in rheumatoid arthritis. UpToDate,

9. Bombard T. Neurotrauma Review Series Part 3: What’s In a Dermatome? EMS World,

10. Moore EE, Feliciano DV, Mattox KL. Trauma, 8th ed. McGraw-Hill Education, 2017.

11. Burton JH, Dunn MG, Harmon NR, et al. A statewide, prehospital emergency medical service selective patient spine immobilization protocol. J Trauma, 2006 Jul; 61(1): 161–7.

12. Maarouf A, McQuown CM, Frey JA, et al. Iatrogenic spinal cord injury in a trauma patient with ankylosing spondylitis. Prehosp Emerg Care, 2017 May–Jun; 21(3): 390–4.

13. Velopulos CG, Shihab HM, Lottenberg L, et al. Prehospital spine immobilization/spinal motion restriction in penetrating trauma: A practice management guidelines from the Eastern Association for the Surgery of Trauma (EAST). J Trauma Acute Care Surg, 2018 May; 84(5): 736–44.

14. Dixon M, O’Halloran J, Cummins NM. Biomechanical analysis of spinal immoblisation during prehospital extrication: a proof of concept study. Emerg Med J, 2014 Sep; 31(9): 745–9.

15. Cowley A, Hague A, Durge N. Cervical spine immobilization during extrication of the awake patient: A narrative review. Eur J Emerg Med, 2017 Jun; 24(3): 158–61.

16. Krell JM, McCoy MS, Sparto PJ, et al. Comparison of the Ferno scoop stretcher with the long backboard for spinal immobilization. Prehosp Emerg Care, 2006 Jan–Mar; 10(1): 46–51.

17. Guly HR, Bouamra O, Lecky FE; Trauma Audit and Research Network. The incidence of neurogenic shock in patients with isolated spinal cord injury in the emergency department. Resuscitation, 2008 Jan; 76(1): 57–62.

18. Go S. “Spine Trauma.” In: Tintinalli JE, Stapczynski JS, Ma OJ, et al., eds. Tintinalli’s Emergency Medicine, 8th ed. McGraw-Hill Education, 2016.

19. Zipnick RI, Scalea TM, Trooskin SZ, et al. Hemodynamic responses to penetrating spinal cord injuries. J Trauma, 1993 Oct; 35(4): 578–82. 

20. Casha S, Christie S. A systematic review of intensive cardiopulmonary management after spinal cord injury. J Neurotrauma, 2011 Aug; 28(8): 1,479–95.

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