This tutorial looks at the devastating problem that is neurogenic shock. A young male is involved in a motor vehicle crash. He cannot move his legs at the scene. Not long after arrival to the emergency room he becomes hypotensive and bradycardic. This tutorial looks at the mechanisms behind spinal cord injury, the pathophysiology and the management. Neurogenic shock involves disruption of the autonomic nervous system. It manifests as vasoplegia, and is treated, once the patient has been adequately resuscitated, with norepinephrine. Injuries above the T4 spinal level may also be associated with bradycardia, due to loss of the cardiac accelerator nerves. In that situation, chronotropic agents may also be required (epinephrine, dopamine etc). Neurogenic shock usually resolves over a 72 hour period but may persist for weeks and months as autonomic dysreflexia.