CFRN Neurological Trauma Management 4

Question 1

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

Accepted Answer

Cortical or subcortical white matter pathways above the midbrain

Answer

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.

Question 2

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

Accepted Answer

30-degree elevation with midline head position

Answer

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

Question 3

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

Accepted Answer

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

Answer

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

Question 4

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

Accepted Answer

Elevated intracranial pressure transmitted through the open fontanelle

Answer

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.

Question 5

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

Accepted Answer

Lidocaine 1.5 mg/kg IV given 3 minutes before intubation

Answer

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

CFRN - Certified Flight Registered Nurse Practice Test

CFRN - Certified Flight Registered Nurse Practice Test

CFRN Neurological Trauma Management 4