ATLS Head Trauma 2

Question 1

A patient arrives with a GCS of 6 after a fall. CT shows an acute epidural hematoma >30 mL with 8 mm of midline shift. What is the most appropriate management?

Accepted Answer

Emergent craniotomy for evacuation

Answer

Medical management with mannitol and hyperventilation

Answer

Serial CT scans every 6 hours

Answer

Intracranial pressure monitor placement only

Question 2

What is the initial target for cerebral perfusion pressure (CPP) in a patient with severe traumatic brain injury?

Accepted Answer

60-70 mmHg

Answer

40-50 mmHg

Answer

80-90 mmHg

Answer

Above 100 mmHg

Question 3

A patient with a GCS of 14 and brief loss of consciousness undergoes CT showing a small subdural hematoma with no midline shift. What is the most appropriate management?

Accepted Answer

Neurological observation with repeat CT in 6-8 hours

Answer

Emergent craniotomy

Answer

Immediate burr hole placement

Answer

Discharge with return precautions

Question 4

Which finding on clinical examination is the earliest sign of uncal herniation?

Accepted Answer

Ipsilateral pupillary dilation

Answer

Bilateral fixed dilated pupils

Answer

Contralateral hemiplegia

Answer

Decerebrate posturing

Question 5

Hyperventilation to a PaCO2 of 30-35 mmHg in severe TBI should be used in which situation?

Accepted Answer

As a temporizing measure for acute signs of herniation

Answer

Routinely to prevent intracranial hypertension

Answer

Continuously for the first 48 hours

Answer

Only after ICP above 40 mmHg

Question 6

What is the GCS score for a patient who opens eyes to pain, makes incomprehensible sounds, and exhibits flexion withdrawal to pain?

Accepted Answer

GCS 8

Answer

GCS 7

Answer

GCS 9

Answer

GCS 10