Neurological Trauma Management Flashcards

A trauma patient is found unresponsive with decorticate posturing. Which brain region is most likely affected?

Answer: Cortical or subcortical white matter pathways above the midbrain

Decorticate posturing (flexion of arms, extension of legs) indicates disruption of cortical or subcortical pathways above the level of the red nucleus in the midbrain.

When managing a patient with suspected increased ICP, what is the recommended head-of-bed position during transport?

Answer: 30-degree elevation with midline head position

Elevating the head 30 degrees in the midline optimizes cerebral venous drainage without significantly compromising MAP or CPP.

A flight nurse prepares to administer ketamine for sedation in a TBI patient. What is the current evidence-based stance on this practice?

Answer: Ketamine is acceptable when used with controlled ventilation and does not significantly worsen ICP

Current evidence suggests ketamine does not significantly raise ICP in ventilated, normoventilated TBI patients and offers hemodynamic stability, making it a viable option.

A pediatric patient with TBI has a bulging fontanelle and is bradycardic. What does the bulging fontanelle indicate in this context?

Answer: Elevated intracranial pressure transmitted through the open fontanelle

A tense or bulging fontanelle in an infant with altered mental status and bradycardia indicates elevated ICP—the open fontanelle provides a clinical window into intracranial dynamics.

Which medication should be given prophylactically during RSI for TBI to blunt the ICP spike from laryngoscopy?

Answer: Lidocaine 1.5 mg/kg IV given 3 minutes before intubation

Lidocaine IV given 3 minutes before laryngoscopy may blunt the catecholamine surge and ICP increase associated with airway manipulation in TBI patients.

A patient with a spinal cord injury above T6 develops sudden hypertension (BP 210/115), bradycardia, and pounding headache during a Foley catheter change. What condition is occurring?

Answer: Autonomic dysreflexia triggered by a noxious stimulus below the level of injury

Autonomic dysreflexia is a life-threatening exaggerated sympathetic reflex in SCI above T6, triggered by a noxious stimulus (e.g., bladder distension) causing severe hypertension.

During fixed-wing transport, a TBI patient is on a ventilator. Which EtCO2 parameter should the flight nurse target to avoid secondary brain injury?

Answer: 35-45 mmHg (normocapnia)

Normocapnia (EtCO2 35-45 mmHg) is the standard goal in TBI; hypocapnia causes cerebral vasoconstriction and ischemia, while hypercapnia causes vasodilation and worsens ICP.