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

An epidural hematoma >30 mL with significant midline shift and depressed GCS requires emergent surgical evacuation.

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

The recommended CPP target in severe TBI is 60-70 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

A small subdural hematoma without significant mass effect in an alert patient is managed with neurological observation and repeat imaging.

Question 4

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

Accepted Answer

Ipsilateral pupillary dilation

Answer

Ipsilateral pupillary dilation from CN III compression against the tentorial edge is the earliest sign of uncal herniation.

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

Brief hyperventilation is a temporizing measure for acute herniation signs, as cerebral vasoconstriction reduces ICP rapidly but can cause ischemia if prolonged.

ATLS - Advanced Trauma Life Support Practice Test

ATLS - Advanced Trauma Life Support Practice Test

ATLS Head Trauma 2