Neurological Trauma Management Flashcards

Which medication is the first-line osmotic agent for managing elevated ICP during aeromedical transport?

Answer: Mannitol 20% or hypertonic saline (3% NaCl)

Mannitol and hypertonic saline are the primary osmotic agents used to reduce ICP by drawing fluid from brain tissue into the vasculature.

A spinal cord injury patient develops neurogenic shock during flight. Which hemodynamic profile is expected?

Answer: Hypotension with bradycardia and warm skin

Neurogenic shock results from loss of sympathetic tone below the injury, causing vasodilation (warm skin), hypotension, and paradoxical bradycardia.

When should the flight nurse perform RSI for a head-injured patient with a GCS of 8?

Answer: Before transport to secure the airway and prevent aspiration

GCS ≤ 8 indicates inability to protect the airway; RSI should be performed before transport when possible to prevent secondary injury from hypoxia.

A patient with a TBI is receiving mannitol. What lab value must be monitored to avoid toxicity?

Answer: Serum osmolality should remain below 320 mOsm/kg

Serum osmolality above 320 mOsm/kg increases risk of mannitol-induced renal failure and paradoxical ICP elevation from mannitol accumulation in brain tissue.

During altitude ascent, a patient with a known subdural hematoma shows acute neurological deterioration. What is the most likely cause?

Answer: Gas expansion at altitude increasing intracranial volume and ICP

Boyle's Law dictates that gas expands at altitude; any intracranial air (pneumocephalus) or gas-containing hematoma can expand and worsen ICP.

Which clinical finding differentiates central cord syndrome from anterior cord syndrome?

Answer: Central cord has greater motor weakness in arms than legs; anterior cord has complete motor loss but preserves posterior column function

Central cord syndrome disproportionately affects the upper extremities and bladder function; anterior cord syndrome causes loss of motor function and pain/temperature but spares proprioception and vibration.

A patient with TBI has a serum sodium of 118 mEq/L and cerebral edema. What syndrome does this suggest?

Answer: Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

SIADH after TBI causes dilutional hyponatremia with euvolemia or mild hypervolemia due to excess ADH release from hypothalamic/pituitary dysfunction.