CFRN Neurological Trauma Management 3

Question 1

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

Accepted Answer

Mannitol 20% or hypertonic saline (3% NaCl)

Answer

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?

Accepted Answer

Hypotension with bradycardia and warm skin

Answer

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?

Accepted Answer

Before transport to secure the airway and prevent aspiration

Answer

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?

Accepted Answer

Serum osmolality should remain below 320 mOsm/kg

Answer

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?

Accepted Answer

Gas expansion at altitude increasing intracranial volume and ICP

Answer

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

CFRN - Certified Flight Registered Nurse Practice Test

CFRN - Certified Flight Registered Nurse Practice Test

CFRN Neurological Trauma Management 3