Spinal Cord Injury Progression: Spinal Shock → Neurogenic Shock → Autonomic Dysreflexia
These three SCI complications happen at different times, present with opposite vital sign patterns, and demand completely different interventions. Picking the wrong one — treating autonomic dysreflexia like neurogenic shock by pushing fluids — can kill the patient. The NCLEX expects you to match the timeline to the presentation to the action.
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Comparison
Spinal Shock
What's happening- Temporary loss of cord function below injury
Key findings- ★Areflexia, flaccid paralysis below level
- Onset at injury
- lasts days–6 weeks
Nursing focus- Immobilize/stabilize spine
- Serial neuro checks
- DVT & skin care
Neurogenic Shock
What's happening- Lost sympathetic tone (T6 and above)
Key findings- ★Hypotension + bradycardia
- Warm, dry, flushed skin (not cold)
Nursing focus- IV fluids first, then vasopressors
- Atropine for bradycardia
- keep flat
Escalate when- MAP/BP falling despite fluids then pressors
Autonomic Dysreflexia
What's happening- Uninhibited sympathetic surge below lesion
Key findings- ★Severe HTN (SBP 250–300) + bradycardia
- Pounding HA
- flushed above / pale below lesion
Nursing focus- Sit upright immediately
- Remove trigger: #1 distended bladder
Escalate when- SBP stays critical then fast antihypertensive
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No reflexes = spinal shock; warm and hypotensive = neurogenic; hypertensive crisis with headache = dysreflexia — sit up, find the trigger.
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