Treatment Protocols & Therapeutic Interventions Flashcards

Which first-tier step lowers raised intracranial pressure in a ventilated TBI patient?

Answer: Raise the head of bed to 30 degrees with the neck midline

Raising the head and keeping the neck midline improves venous drainage and lowers ICP with little risk.

The Brain Trauma Foundation recommends treating ICP above what value in severe TBI?

Answer: 22 mmHg

The 4th-edition BTF guidelines advise treating ICP above 22 mmHg because higher values are linked to higher mortality.

Prophylactic phenytoin or levetiracetam after severe TBI is mainly meant to prevent:

Answer: Early post-traumatic seizures in the first 7 days

Seizure prophylaxis reduces early (≤7 days) post-traumatic seizures but does not prevent late epilepsy.

Which medication is first-line for spasticity after spinal cord injury and works as a GABA-B agonist?

Answer: Baclofen

Baclofen is a GABA-B receptor agonist that reduces spinal reflex activity and is a mainstay for spasticity.

Abruptly stopping intrathecal baclofen most often leads to:

Answer: Rebound spasticity, high fever, altered mental status, and possible rhabdomyolysis

Intrathecal baclofen withdrawal is a life-threatening emergency that can look like sepsis or neuroleptic malignant syndrome.

Botulinum toxin injections ease focal spasticity by:

Answer: Blocking acetylcholine release at the neuromuscular junction

Botulinum toxin cleaves SNARE proteins and stops acetylcholine release, causing temporary local muscle weakness.

Which acute treatment for autonomic dysreflexia in a T4 spinal cord injury patient should come first?

Answer: Sit the patient upright and find and remove the noxious trigger (such as checking the bladder)

Sitting up lowers BP through orthostasis, and removing the trigger (often a blocked catheter or bowel) ends the reflex.