Exclude other causes of shock!
Judicious IVF with normal saline, with UOP >30 cc/hr
Hypotonic fluids such as D5W and 0.45% NS are contraindicated
Albumin is relatively contraindicated as compared to NS
Norepinephrine first line, with MAP goal of 85-90 for the first 5-7 days after spinal cord injury
Consider adding phenylephrine if BP refractory to first line agent
Phenylephrine alone without beta-1 stimulation will cause reflex bradycardia
Atropine if needed, keeping HR 60-100 bpm in NSR
May titrate down on norepinephrine and atropine, to favor more phenylephrine α agonism in ICU setting
Hypotonic fluids such as D5W and 0.45% NS are contraindicated
Albumin is relatively contraindicated as compared to NS
Consider adding phenylephrine if BP refractory to first line agent
Phenylephrine alone without beta-1 stimulation will cause reflex bradycardia
Atropine if needed, keeping HR 60-100 bpm in NSR
May titrate down on norepinephrine and atropine, to favor more phenylephrine α agonism in ICU setting<unk>  management
Consider intubation injuries at C5 or above
Manual in-line stabilization reduces cervical movement better than C-collar, but be careful of tracheal pressures inadvertently applied which can worsen laryngeal visualization
Direct laryngoscopy causes C-spine extension at atlanto-occipital junction, C1-C2, and C4-C7 in order from most to least
Consider video laryngoscopy with hyperangulated stylet or bougie assisted DL to intubate higher-grade laryngoscopy views of vocal cords without C-spine overextension
Post-intubation sedation takes into consideration hemodynamics and potential intraoperative EMG and evoked potential monitoring by anesthesia
Opioids do not impact evoked potential monitoring
Ketamine may enhance evoked potential monitoring
Consider dexmedetomidine as a Propofol sparing medication in TIVA
Consider surgical intervention for:
Progressive neurologic deficits
Unstable spine fractures
Steroids are no longer recommended
Administration of methylprednisolone (MP) for the treatment of acute spinal cord injury (SCI) is not recommended. Clinicians considering MP therapy should bear in mind that the drug is NOT approved by the FDA for this indication. There is no Class I or Class II medical evidence supporting the clinical benefit of MP in the treatment of acute SCI. Scattered reports of Class III evidence claim inconsistent effects likely related to random chance or selection bias. However, Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death.
See EBQ:High Dose Steroids in Cord Injury for further discussion
Manual in-line stabilization reduces cervical movement better than C-collar, but be careful of tracheal pressures inadvertently applied which can worsen laryngeal visualization
Direct laryngoscopy causes C-spine extension at atlanto-occipital junction, C1-C2, and C4-C7 in order from most to least
Consider video laryngoscopy with hyperangulated stylet or bougie assisted DL to intubate higher-grade laryngoscopy views of vocal cords without C-spine overextension
Post-intubation sedation takes into consideration hemodynamics and potential intraoperative EMG and evoked potential monitoring by anesthesia
Opioids do not impact evoked potential monitoring
Ketamine may enhance evoked potential monitoring
Consider dexmedetomidine as a Propofol sparing medication in TIVA
Opioids do not impact evoked potential monitoring
Ketamine may enhance evoked potential monitoring
Consider dexmedetomidine as a Propofol sparing medication in TIVA
Progressive neurologic deficits
Unstable spine fractures
Administration of methylprednisolone (MP) for the treatment of acute spinal cord injury (SCI) is not recommended. Clinicians considering MP therapy should bear in mind that the drug is NOT approved by the FDA for this indication. There is no Class I or Class II medical evidence supporting the clinical benefit of MP in the treatment of acute SCI. Scattered reports of Class III evidence claim inconsistent effects likely related to random chance or selection bias. However, Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death.
See EBQ:High Dose Steroids in Cord Injury for further discussion
Prevent hypothermia - consider temperature probe Foley
High risk of VTE in paraparesis or tetraparesis
Up to 40% in non-prophylaxed
Must weigh benefits of VTE prophylaxis and risk of bleed from LMWH
Low dose SC heparin at 500 units q8hrs plus SCDs may be alternative
Up to 40% in non-prophylaxed
Must weigh benefits of VTE prophylaxis and risk of bleed from LMWH
Low dose SC heparin at 500 units q8hrs plus SCDs may be alternative
Neurogenic shock
Cardiogenic
Spinal shock
Acute valvular Regurgitation/VSD
Undifferentiated shock 
CHF
Undifferentiated shock
Dysrhythmia