Prehospital Trauma Life Support (PHTLS) Practice Test

Which assessment is most beneficial for differentiating hemorrhagic shock from neurogenic shock?

1. Abdomen

2. Blood pressure

3. Neurologic status

4. Skin

The correct answer is: Skin

Differentiating hemorrhagic shock from neurogenic shock is crucial in providing appropriate prehospital care. In this context, assessing the skin is particularly beneficial because it can reveal key differences between the two types of shock. In hemorrhagic shock, which results from significant blood loss, the patient typically exhibits signs of poor perfusion. This often manifests as cool, clammy, pale skin due to vasoconstriction as the body tries to redirect blood flow to vital organs. This is a physiological response to maintain perfusion in the face of declining blood volume. Conversely, neurogenic shock is characterized by loss of sympathetic tone due to spinal cord injury or disruption of nerve pathways, leading to vasodilation. Patients experiencing neurogenic shock often present with warm, flushed, dry skin due to the inability of blood vessels to constrict effectively, even in the face of low blood pressure. Therefore, by examining the skin characteristics—specifically looking for cool and clammy versus warm and dry—healthcare providers can gain valuable insight into whether a patient is experiencing hemorrhagic shock versus neurogenic shock. This assessment can guide further interventions and treatments, making skin assessment a critical tool in distinguishing between these two types of shock.