CFRN Neurological Trauma Management 3 — Questions and Answers
Question 1: Which medication is the first-line osmotic agent for managing elevated ICP during aeromedical transport?
- Mannitol 20% or hypertonic saline (3% NaCl) (Correct answer)
- Furosemide alone
- Dexamethasone
- Albumin 5%
Correct 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.
Question 2: A spinal cord injury patient develops neurogenic shock during flight. Which hemodynamic profile is expected?
- Hypotension with bradycardia and warm skin (Correct answer)
- Hypotension with tachycardia and cool clammy skin
- Hypertension with bradycardia and diaphoresis
- Normal BP with tachycardia and peripheral vasoconstriction
Correct 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.
Question 3: When should the flight nurse perform RSI for a head-injured patient with a GCS of 8?
- Before transport to secure the airway and prevent aspiration (Correct answer)
- Only if SpO2 drops below 85% in flight
- After arrival at the receiving facility when surgical team is available
- Only if the patient becomes combative or apneic
Correct 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.
Question 4: A patient with a TBI is receiving mannitol. What lab value must be monitored to avoid toxicity?
- Serum osmolality should remain below 320 mOsm/kg (Correct answer)
- Serum sodium should be kept below 130 mEq/L
- Blood glucose must stay above 200 mg/dL
- Serum potassium must stay above 5.0 mEq/L
Correct 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.
Question 5: During altitude ascent, a patient with a known subdural hematoma shows acute neurological deterioration. What is the most likely cause?
- Gas expansion at altitude increasing intracranial volume and ICP (Correct answer)
- Hypoxia from reduced ambient oxygen partial pressure
- Hyperventilation-induced cerebral vasodilation
- Cold-induced coagulopathy worsening the bleed
Correct 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.
Question 6: Which clinical finding differentiates central cord syndrome from anterior cord syndrome?
- Central cord has greater motor weakness in arms than legs; anterior cord has complete motor loss but preserves posterior column function (Correct answer)
- Central cord has complete motor and sensory loss; anterior cord has only sensory deficits
- Central cord preserves all motor function; anterior cord eliminates all sensation
- Central cord and anterior cord have identical presentations
Correct 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.
Question 7: A patient with TBI has a serum sodium of 118 mEq/L and cerebral edema. What syndrome does this suggest?
- Syndrome of Inappropriate Antidiuretic Hormone (SIADH) (Correct answer)
- Cerebral Salt Wasting (CSW)
- Diabetes Insipidus (DI)
- Hyperaldosteronism
Correct 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.
CFRN Neurological Trauma Management 3
Which medication is the first-line osmotic agent for managing elevated ICP during aeromedical transport?