Differentiating Hemorrhagic and Neurogenic Shock: Vital Signs Assessment in Prehospital Care
The most critical prehospital assessment to distinguish hemorrhagic shock from neurogenic shock is blood pressure measurement combined with clinical context.
Hemorrhagic Shock
- Hypovolemia → Systolic BP typically < 90 mmHg
- Compensatory tachycardia, tachypnea
- Cool, pale, clammy skin (peripheral vasoconstriction)
Neurogenic Shock
- Loss of sympathetic tone → vasodilation with normal blood volume
- BP may be normal or only mildly decreased
- Warm, dry skin (loss of vasoconstriction)
- Often bradycardia (unopposed vagal tone)
Rapid identification guides fluid resuscitation vs. vasopressor strategy.
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