Neurogenic shock Quiz: Ace Your Exams

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A 44-year-old woman presents to the emergency department following a fall off a mountain bicycle. The patient landed directly onto her back. She has a GCS of 10 due to absent motor response. She opens her eyes spontaneously and is oriented to person and place. Temperature is 36°C (96.8°F), blood pressure is 74/44 mmHg, heart rate is 44/min, respiratory rate is 12/min, and oxygen saturation is 98% on room air. Airway and breathing are intact. Physical examination demonstrates diffuse bruising and ecchymosis over the spine. The patient is unable to move her lower extremities when prompted. She has no sensation below the nipple line. A focused assessment with sonography for trauma (FAST) is negative. CT imaging of the spine demonstrates a burst fracture with associated epidural hemorrhage at the T4 spinal level. The patient is provided with 3 liters of intravenous fluids with a repeat blood pressure of 70/44 mmHg. Which of the following is the best next step in management?  

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