PHTLS - Prehospital Trauma Life Support Prehospital Trauma Life Support Traumatic Brain Injury 1

Question 1

Under what specific circumstance does PHTLS permit controlled hyperventilation in a TBI patient?

Accepted Answer

Only when clinical signs of herniation are present, such as posturing or a blown pupil

Answer

Routinely for any patient with a GCS below 9

Answer

Whenever SpO2 falls below 92% despite supplemental oxygen

Answer

When systolic blood pressure exceeds 180 mmHg

Question 2

What minimum SpO2 value should prehospital providers maintain in a patient with suspected TBI according to PHTLS?

Accepted Answer

94%

Answer

88%

Answer

90%

Answer

98%

Question 3

Which set of findings constitutes Cushing's triad and what does it signal in a TBI patient?

Accepted Answer

Hypertension, bradycardia, and irregular respirations — indicating severely elevated ICP with impending herniation

Answer

Tachycardia, hypotension, and bradypnea — indicating spinal shock

Answer

Hypotension, tachycardia, and tachypnea — indicating hemorrhagic shock

Answer

Fever, hypertension, and tachycardia — indicating neurogenic fever

Question 4

What is the primary mechanism responsible for secondary brain injury following the initial TBI impact?

Accepted Answer

Hypoxia and hypotension causing ischemia in vulnerable, already-injured brain tissue

Answer

Direct axonal shearing forces generated at the moment of impact

Answer

Skull fracture fragments continuing to lacerate brain parenchyma after the event

Answer

Immediate cerebral edema that forms within seconds of the primary injury

Question 5

A TBI patient has a GCS of 7 and cannot protect their airway. What is the PHTLS-recommended airway approach and ventilation rate for an adult?

Accepted Answer

Advanced airway placement with ventilation at approximately 10 breaths per minute

Answer

Recovery position with high-flow oxygen via non-rebreather mask only

Answer

Bag-valve-mask ventilation at 20 breaths per minute to ensure adequate oxygenation

Answer

Nasopharyngeal airway insertion and allow the patient to breathe spontaneously

Question 6

What does the 'talk and die' phenomenon describe in the context of TBI, and why is it clinically important?

Accepted Answer

A patient may have a lucid interval after TBI and then deteriorate rapidly as an intracranial hematoma expands

Answer

Patients who are verbal at the scene never develop significant intracranial pathology

Answer

Verbal responsiveness on scene confirms that no airway intervention will be required during transport

Answer

A GCS verbal score of 5 reliably predicts survival from severe head trauma