A 30-year-old man is brought to the emergency department following a high-speed car accident. He was the driver, and the windshield of the car was broken. On examination, he is alert, awake, oriented, and in no respiratory distress. He is unable to move any of his four extremities; however, his extremities are warm and pink. His vital signs on admission are HR 54 bpm and BP 70/40 mm Hg. What is the diagnosis?

Neurogenic shock (not to be confused with spinal shock, which is defined by loss of reflexes below the area of spinal cord injury, a neurologic phenomena) is secondary to high spinal cord injury as evidenced by inability to move all four extremities. Neurogenic shock is clinically manifested by warm skin, bradycardia, and hypotension. In septic shock, while the skin is warm, the patient usually has tachycardia. In all other types of shock, the skin is cold. Treatment consists of volume replacement with balanced salt solution (lactated Ringer's solution). On rare occasions, some patients may need vasoconstrictors (e.g., phenylephrine hydrochloride).