Neurological Trauma Management Flashcards

A patient with TBI is being transported and has a seizure lasting 3 minutes. What is the first-line pharmacological treatment?

Answer: Lorazepam or diazepam IV

Benzodiazepines (lorazepam or diazepam) are the first-line treatment for acute seizures, including post-traumatic seizures, due to rapid onset and efficacy.

Battle's sign, a clinical indicator of basilar skull fracture, refers to ecchymosis over which anatomical area?

Answer: Mastoid process posterior to the ear

Battle's sign is ecchymosis over the mastoid process, resulting from blood tracking along the skull base fracture, typically appearing 12-24 hours post-injury.

A patient with a diffuse axonal injury (DAI) is being transported. What GCS range and CT finding is most characteristic of DAI?

Answer: Low GCS (3-8) with normal or subtly abnormal CT scan

DAI is caused by rotational shear forces disrupting axons; CT is often normal or shows only small petechial hemorrhages despite severe neurological dysfunction.

A patient with a C5 spinal cord injury is being transported on a backboard. What pressure injury concern requires immediate attention?

Answer: Occiput and sacrum are highest-risk bony prominences requiring padding

SCI patients have impaired sensation and vasomotor control, dramatically accelerating pressure injury formation; pad all bony prominences, especially occiput, sacrum, and heels, even during brief transports.

When assessing spinal cord injury level, a patient has intact biceps (C5), absent wrist extensors, and no hand function. At what level is the neurological injury?

Answer: C6

Wrist extensors are innervated by C6; their absence with intact C5 function localizes the injury to C6 as the most caudal intact motor level.

A TBI patient in transport develops diabetes insipidus (DI). Which set of findings confirms this diagnosis?

Answer: Polyuria with dilute urine, rising serum sodium, and decreased urine osmolality

Post-traumatic DI results from hypothalamic/posterior pituitary dysfunction causing ADH deficiency, leading to massive dilute urine output, hypernatremia, and low urine osmolality.

Which scoring tool is used specifically to predict outcomes and guide prognosis discussions for moderate-to-severe TBI patients during transport handoff?

Answer: IMPACT score or Marshall CT Classification

The IMPACT (International Mission for Prognosis and Analysis of Clinical Trials in TBI) score and Marshall CT Classification are validated tools for TBI outcome prediction used in handoff communication.