 If you haven't already done so, please watch the other video that actually discusses the mechanism of injury and the signs and symptoms and treatment and nursing care of spinal cord injury in a separate video. And then neurogenic shock is a little bit different, which can occur 30 minutes to six weeks after the injury. And it is a distributive type of shock. Remember there are different types of shocks and neurogenic shock falls into the distributive category here. And that usually occurs when there's an injury either to the brain, the cervical or thoracic spine, so high level spinal cord injuries. And it means that there is a loss of the autonomic nervous system control to the blood vessels because now again there is no communication from the brain all the way down to the blood vessels. And so the patient loses their sympathetic nervous system and the sympathetic tone to their blood vessels, which results in massive vasodilation. Keep in mind the sympathetic nervous system usually helps with vasoconstriction, but now we don't have that because it's impaired. So it results in massive vasodilation and which will result in significant hypotension that can lead to tissue hyperperfusion and then impaired cellular metabolism and cell death. It's basically low perfusion, no oxygen to the tissues means the cells are going to die. So signs and symptoms include significant hypotension because of this massive vasodilation, but also the heart rate goes down and the temperature might be elevated or it might be low depending on what is going on with the patient in terms of how they can adjust to the external environment if at all. Now treatment for this includes again spinal stabilization as in anybody with spinal cord injury, the administration of vasopressors to help constrict these blood vessels and bring the blood pressure up to ensure the tissue perfusion and those usually include ulnar epinephrine which is also called liver fat or phenolephrine which is also called neosinephrine and then the patient because of the low heart rate here might also need atropine which basically counteracts the influence of the parasympathetic nervous system or the patient might need a pacemaker. Now this can be so significant like I just said that the patient might need a permanent pacemaker because this can last up to six weeks and we can't just continue giving the patient atropine.