Shock Quiz: Ace Your Exams

A 32-year-old male is brought to the emergency department after being involved in a high speed motor vehicle collision. Per paramedics, the patient was the restrained driver and was rear-ended by another vehicle traveling approximately 60 miles per hour. The patient endorses difficulty moving his arms and legs, and endorses pain to the back of his neck. He is otherwise healthy and does not take any medications. Temperature is 37.0°C (98.6°F), pulse is 42/min, respirations are 17/min, blood pressure is 80/60 mmHg, and O₂ saturation is 97% on room air. On physical exam, the patient has a large bruise over the anterior chest wall and abdomen. Cardiopulmonary exam is otherwise unremarkable. He is unable to move his arms or legs to command and has absent reflexes below the C6 level. Which of the following best describes the underlying pathophysiology resulting in this patient’s clinical presentation?