**2. Clinical evaluation**

Resuscitation, hemodynamic stabilization, and clinical assessment of a patient with spinal shock are a simultaneous and ongoing process [4, 8]. Clinical details include a detailed history of the mode and mechanism of injury (hit by another vehicle, fall, rollover crash, ejection outside the car, or seat belt was used or not), any history of alcohol intoxication, history of any comorbid conditions, and a detailed spine and physical examination of all the systems to exclude any associated injuries or dysfunctions [14]. Neurological examination includes assessment of the level of consciousness, motor and sensory functions, and assessment of deep tendon and superficial reflexes [15–17]. This will help determine the lesion's level and the extent of neurological impairment. Additionally, attention should be paid to determine the associated autonomic dysfunction (including bowel and bladder disturbance), autonomic dysreflexia, and the presence and extent of cardiovascular dysfunctions [18]. Involvement of the respiratory system, particularly intercostal muscles and diaphragm, can result in respiratory compromise. Early recognition and appropriate intervention (elective ventilation, early tracheostomy), including chest physiology, will help recover respiratory functions.
