PHTLS Traumatic Brain Injury 2

Question 1

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?

Accepted Answer

Restore systolic BP to ≥90 mmHg as quickly as possible

Answer

Administer mannitol immediately

Answer

Hyperventilate to reduce ICP

Answer

Perform rapid sequence intubation before fluid resuscitation

Question 2

Which herniation pattern is characterized by unilateral fixed and dilated pupil combined with contralateral motor weakness?

Accepted Answer

Uncal (transtentorial) herniation

Answer

Central herniation

Answer

Tonsillar herniation

Answer

Upward cerebellar herniation

Question 3

In the context of TBI, what does the Monroe-Kellie doctrine state?

Accepted Answer

The skull is a rigid compartment so any volume increase must displace another component

Answer

Cerebral perfusion pressure equals MAP minus ICP

Answer

Autoregulation is lost at a CPP below 50 mmHg

Answer

Cerebral blood flow is directly proportional to PaCO2

Question 4

A TBI patient is breathing at a rate of 6 breaths per minute. What is the PHTLS-recommended bag-valve-mask intervention?

Accepted Answer

Assist ventilations to achieve 10 breaths/min for adults

Answer

Assist ventilations to achieve 20 breaths/min

Answer

Allow the patient to self-regulate and provide supplemental O2 only

Answer

Immediately hyperventilate at 20 breaths/min to decrease ICP

Question 5

Which of the following BEST describes cerebral perfusion pressure (CPP)?

Accepted Answer

Mean arterial pressure minus intracranial pressure

Answer

Systolic BP minus diastolic BP

Answer

Diastolic BP minus intracranial pressure

Answer

Systolic BP minus intracranial pressure

Question 6

During transport of a severe TBI patient, SpO2 drops to 88%. What is the correct action?

Accepted Answer

Increase supplemental oxygen and reassess airway positioning immediately

Answer

Continue transport without adjustment as this is acceptable in trauma

Answer

Hyperventilate the patient to compensate

Answer

Administer furosemide to reduce cerebral edema

Question 7

A helmeted motorcyclist is unresponsive after a crash. When should the helmet be removed in the prehospital setting?

Accepted Answer

Only if it prevents airway assessment or management

Answer

Never; always leave the helmet in place until arrival at the ED

Answer

Immediately and always, to assess for skull fractures

Answer

Only if the patient is conscious and requests removal