ITLS Head and Spinal Trauma 3

Question 1

What is neurogenic shock, and how does it differ from hypovolemic shock in its presentation?

Accepted Answer

Neurogenic shock presents with hypotension and bradycardia due to loss of sympathetic tone, while hypovolemic shock presents with hypotension and tachycardia

Answer

Neurogenic shock results from spinal cord injury disrupting sympathetic outflow, causing vasodilation (hypotension) and unopposed vagal tone (bradycardia)—the opposite of the tachycardia seen in hypovolemic shock.

Question 2

A patient dove into shallow water and has quadriplegia with loss of sensation below the clavicles. At what spinal level is the injury most likely?

Accepted Answer

C3-C4

Answer

Quadriplegia with a sensory level at the clavicles corresponds to the C3-C4 dermatome. The clavicle is innervated by the C3-C4 supraclavicular nerves.

Question 3

What are the signs of a basilar skull fracture that ITLS providers should recognize?

Accepted Answer

Battle's sign (mastoid ecchymosis), raccoon eyes (periorbital ecchymosis), CSF rhinorrhea/otorrhea, and hemotympanum

Answer

Basilar skull fractures present with characteristic signs: Battle's sign, raccoon eyes, CSF leaking from the nose or ears, and blood behind the tympanic membrane, all resulting from fractures at the base of the skull.

Question 4

Why is hyperventilation no longer recommended as routine management for traumatic brain injury?

Accepted Answer

Hyperventilation causes cerebral vasoconstriction that reduces ICP but also reduces cerebral blood flow, potentially worsening ischemia in the already injured brain

Answer

While hyperventilation effectively lowers ICP by causing cerebral vasoconstriction and reducing cerebral blood volume, it simultaneously reduces cerebral blood flow, which can worsen ischemia in the injured brain that already has compromised perfusion.

Question 5

A patient has a penetrating object (knife) embedded in the skull. What is the correct prehospital management?

Accepted Answer

Stabilize the object in place, control bleeding around it, and transport for surgical removal

Answer

Embedded objects in the skull must never be removed in the field, as they may be tamponading blood vessels or plugging the dural defect. Stabilize in place with bulky dressings and transport for neurosurgical removal.

ITLS - International Trauma Life Support Practice Test

ITLS - International Trauma Life Support Practice Test

ITLS Head and Spinal Trauma 3