A trauma patient with a 20-foot fall displays hypotension and pale, cool extremities. What injury should be suspected?

In this scenario, where the trauma patient has experienced a significant fall of 20 feet and is now displaying hypotension and pale, cool extremities, a spinal cord injury should be suspected. The symptoms presented, particularly the hypotension and appearance of the extremities, can indicate potential neurogenic shock, which is often associated with high-level spinal cord injuries. These injuries can disrupt the autonomic regulation of cardiovascular function, leading to vasodilation and hypotension.

Additionally, spinal cord injuries can result in the loss of sympathetic tone, causing the blood vessels to dilate and ultimately leading to inadequate blood flow to vital organs. Pale, cool extremities are a reflection of decreased perfusion, further supporting the concern of a spinal cord injury as a primary injury.

While other injuries, such as fractures or abdominal injuries, can also result from a fall, the specific combination of hypotension and extremity changes aligns most closely with the implications of a spinal cord injury in this context.