CFRN Neurological Trauma Management 5 — Questions and Answers
Question 1: A patient with TBI is being transported and has a seizure lasting 3 minutes. What is the first-line pharmacological treatment?
- Lorazepam or diazepam IV (Correct answer)
- Phenytoin IV loading dose
- Levetiracetam oral route
- Propofol infusion only
Correct 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.
Question 2: Battle's sign, a clinical indicator of basilar skull fracture, refers to ecchymosis over which anatomical area?
- Mastoid process posterior to the ear (Correct answer)
- Periorbital region (raccoon eyes)
- The bridge of the nose
- The temporal fossa
Correct 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.
Question 3: A patient with a diffuse axonal injury (DAI) is being transported. What GCS range and CT finding is most characteristic of DAI?
- Low GCS (3-8) with normal or subtly abnormal CT scan (Correct answer)
- High GCS (13-15) with massive hemorrhage on CT
- Moderate GCS (9-12) with large epidural hematoma
- Variable GCS with obvious cortical laceration on CT
Correct 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.
Question 4: A patient with a C5 spinal cord injury is being transported on a backboard. What pressure injury concern requires immediate attention?
- Occiput and sacrum are highest-risk bony prominences requiring padding (Correct answer)
- Skin breakdown only occurs after 6+ hours on a hard surface
- Pressure injuries are not a concern during short transport windows
- The thoracic spine is the highest-risk area for pressure necrosis
Correct 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.
Question 5: 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?
- C6 (Correct answer)
- C5
- C7
- T1
Correct 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.
Question 6: A TBI patient in transport develops diabetes insipidus (DI). Which set of findings confirms this diagnosis?
- Polyuria with dilute urine, rising serum sodium, and decreased urine osmolality (Correct answer)
- Oliguria with concentrated urine and hyponatremia
- Polyuria with concentrated urine and hyperkalemia
- Anuria with elevated BUN and low serum sodium
Correct 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.
Question 7: Which scoring tool is used specifically to predict outcomes and guide prognosis discussions for moderate-to-severe TBI patients during transport handoff?
- IMPACT score or Marshall CT Classification (Correct answer)
- CURB-65 score
- APACHE II score
- Revised Trauma Score (RTS) alone
Correct 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.
CFRN Neurological Trauma Management 5
A patient with TBI is being transported and has a seizure lasting 3 minutes.
What is the first-line pharmacological treatment?