Traumatic Brain Injury Flashcards
21 cards from real PHTLS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 20 Traumatic Brain Injury flashcards as text
A patient with a severe TBI has a GCS of 6 and a systolic BP of 80 mmHg. What is the PHTLS priority for this patient?
Answer: Restore systolic BP to ≥90 mmHg as quickly as possible
Hypotension (SBP <90 mmHg) doubles mortality in severe TBI, so restoring perfusion pressure is the immediate priority.
Which herniation pattern is characterized by unilateral fixed and dilated pupil combined with contralateral motor weakness?
Answer: Uncal (transtentorial) herniation
Uncal herniation compresses CN III on the ipsilateral side, causing a blown pupil, and compresses the cerebral peduncle, causing contralateral weakness.
In the context of TBI, what does the Monroe-Kellie doctrine state?
Answer: The skull is a rigid compartment so any volume increase must displace another component
The Monroe-Kellie doctrine holds that brain, blood, and CSF occupy a fixed skull volume, so expansion of one component compresses the others.
A TBI patient is breathing at a rate of 6 breaths per minute. What is the PHTLS-recommended bag-valve-mask intervention?
Answer: Assist ventilations to achieve 10 breaths/min for adults
PHTLS recommends assisting ventilation to approximately 10 breaths/min in adults to correct hypoventilation without causing harmful hypocapnia.
Which of the following BEST describes cerebral perfusion pressure (CPP)?
Answer: Mean arterial pressure minus intracranial pressure
CPP = MAP − ICP; maintaining adequate CPP is the primary goal in managing severe TBI.
During transport of a severe TBI patient, SpO2 drops to 88%. What is the correct action?
Answer: Increase supplemental oxygen and reassess airway positioning immediately
Hypoxia (SpO2 <90%) causes secondary brain injury; correcting it immediately with supplemental oxygen and airway optimization is the priority.
A helmeted motorcyclist is unresponsive after a crash. When should the helmet be removed in the prehospital setting?
Answer: Only if it prevents airway assessment or management
PHTLS recommends helmet removal when it prevents adequate airway management or assessment, requiring a two-rescuer technique to maintain spinal alignment.
A 30-year-old construction worker fell 20 feet and is confused (GCS 12). His right pupil is 6 mm and non-reactive. Which injury does this MOST suggest?
Answer: Epidural hematoma with uncal herniation
A unilateral blown pupil following head trauma indicates uncal herniation, classically caused by an expanding epidural hematoma from a torn middle meningeal artery.
Which TBI type is MOST commonly associated with rapid arterial bleeding between the skull and dura mater?
Answer: Epidural hematoma
Epidural hematomas result from tearing of the middle meningeal artery, causing rapid accumulation of arterial blood between the skull and the dura.
Which patient population is at HIGHEST risk for subdural hematoma from seemingly minor head trauma?
Answer: Elderly patients on anticoagulants
Cerebral atrophy in the elderly stretches bridging veins, and anticoagulants impair clotting, dramatically increasing subdural hematoma risk even from minor falls.
What is the significance of Cushing's triad in a TBI patient?
Answer: It signals severely elevated ICP and impending brainstem herniation
Cushing's triad (hypertension, bradycardia, irregular respirations) is a late, ominous sign of critically elevated ICP with impending brainstem herniation.
When is brief prophylactic hyperventilation (PaCO2 ~35 mmHg) acceptable in PHTLS guidelines for TBI?
Answer: Only when signs of herniation (blown pupil, posturing) are present
PHTLS permits brief targeted hyperventilation only as a temporizing measure for impending herniation, not as routine ICP management.
A TBI patient exhibits decorticate posturing. Which brain region does this MOST likely indicate injury to?
Answer: Cerebral hemispheres or internal capsule above the midbrain
Decorticate posturing (flexion of arms, extension of legs) indicates disruption of cortical and subcortical motor pathways above the red nucleus in the midbrain.
During secondary assessment of a TBI patient, you note bilateral periorbital ecchymosis. This finding is MOST associated with:
Answer: Basilar skull fracture
Bilateral periorbital ecchymosis ('raccoon eyes') is a classic sign of anterior basilar skull fracture with blood tracking into the periorbital tissues.
A pediatric TBI patient, age 4, has a GCS of 8 and blood pressure of 70/40 mmHg. What is the minimum acceptable systolic BP target in PHTLS for this child?
Answer: 80 mmHg
PHTLS targets a minimum SBP of 80 mmHg for pediatric TBI patients, compared to 90 mmHg for adults, reflecting age-related physiologic norms.
Which prehospital intervention has been shown to MOST reliably reduce secondary brain injury from TBI?
Answer: Prevention and correction of hypoxia and hypotension
Preventing and correcting hypoxia and hypotension are the most impactful prehospital interventions to reduce secondary injury in TBI patients.
A patient with known TBI begins having a generalized tonic-clonic seizure en route to the hospital. After ensuring airway safety, what is the next PHTLS priority?
Answer: Protect the patient from injury and monitor for airway compromise
Seizure management focuses on patient safety (preventing fall injury) and airway protection; definitive anticonvulsant treatment is typically a hospital intervention.
Why is hyperthermia particularly harmful in TBI patients?
Answer: It increases cerebral metabolic demand, worsening ischemia in injured tissue
Hyperthermia raises cerebral metabolic rate, increasing oxygen demand in already-vulnerable injured brain tissue and exacerbating ischemic damage.
A TBI patient who was initially alert (GCS 15) deteriorates to GCS 9 over 20 minutes. This pattern is MOST consistent with:
Answer: Epidural hematoma with an expanding hematoma (lucid interval)
A lucid interval followed by rapid neurologic deterioration is the classic presentation of an expanding epidural hematoma compressing the brain.
When managing a TBI patient's airway with BVM ventilation, what EtCO2 target should be maintained to avoid secondary injury?
Answer: 35–40 mmHg
A target EtCO2 of 35–40 mmHg maintains normocapnia, preventing both vasodilatory hypercarbia and vasoconstrictive hypocapnia.
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