ITLS Head and Spinal Trauma 2

Question 1

A patient struck in the head with a baseball bat initially loses consciousness, then regains awareness and appears lucid for 30 minutes before rapidly deteriorating. What type of intracranial hemorrhage is most likely?

Accepted Answer

Epidural hematoma

Answer

An epidural hematoma, typically from tearing of the middle meningeal artery by a temporal bone fracture, classically presents with a 'lucid interval' followed by rapid neurological decline as the arterial bleed expands.

Question 2

What clinical signs indicate Cushing's triad, and what does it signify?

Accepted Answer

Hypertension, bradycardia, and irregular respirations indicating critically elevated intracranial pressure

Answer

Cushing's triad (hypertension, bradycardia, irregular respirations) is a late and ominous sign of critically elevated ICP with impending brainstem herniation, requiring immediate intervention.

Question 3

A trauma patient has unequal pupils—the right pupil is fixed and dilated while the left is reactive. What does this finding most likely indicate?

Accepted Answer

Right-sided uncal herniation compressing the right oculomotor nerve

Answer

A unilateral fixed, dilated pupil in a trauma patient indicates ipsilateral uncal herniation, where the medial temporal lobe herniates through the tentorial notch and compresses the ipsilateral CN III (oculomotor nerve).

Question 4

A motorcycle crash victim has weakness and loss of pain/temperature sensation in both arms but relatively preserved leg function. What spinal cord injury pattern is this?

Accepted Answer

Central cord syndrome

Answer

Central cord syndrome involves greater motor impairment in the upper extremities than the lower, with variable sensory loss. It occurs from cervical hyperextension that damages the central portion of the spinal cord where upper extremity fibers are located.

Question 5

What is the appropriate blood pressure target when managing a trauma patient with both a severe traumatic brain injury (GCS 6) and hemorrhagic shock?

Accepted Answer

Maintain systolic BP above 90 mmHg to protect cerebral perfusion, even though this conflicts with permissive hypotension strategy

Answer

TBI patients require adequate cerebral perfusion pressure, making hypotension particularly dangerous. When TBI coexists with hemorrhagic shock, maintaining systolic BP above 90 mmHg takes priority over permissive hypotension to prevent secondary brain injury.

ITLS - International Trauma Life Support Practice Test

ITLS - International Trauma Life Support Practice Test

ITLS Head and Spinal Trauma 2