PHTLS Traumatic Brain Injury 3

Question 1

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?

Accepted Answer

Epidural hematoma with uncal herniation

Answer

A unilateral blown pupil following head trauma indicates uncal herniation, classically caused by an expanding epidural hematoma from a torn middle meningeal artery.

Question 2

Which TBI type is MOST commonly associated with rapid arterial bleeding between the skull and dura mater?

Accepted Answer

Epidural hematoma

Answer

Epidural hematomas result from tearing of the middle meningeal artery, causing rapid accumulation of arterial blood between the skull and the dura.

Question 3

Which patient population is at HIGHEST risk for subdural hematoma from seemingly minor head trauma?

Accepted Answer

Elderly patients on anticoagulants

Answer

Cerebral atrophy in the elderly stretches bridging veins, and anticoagulants impair clotting, dramatically increasing subdural hematoma risk even from minor falls.

Question 4

What is the significance of Cushing's triad in a TBI patient?

Accepted Answer

It signals severely elevated ICP and impending brainstem herniation

Answer

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

Question 5

When is brief prophylactic hyperventilation (PaCO2 ~35 mmHg) acceptable in PHTLS guidelines for TBI?

Accepted Answer

Only when signs of herniation (blown pupil, posturing) are present

Answer

PHTLS permits brief targeted hyperventilation only as a temporizing measure for impending herniation, not as routine ICP management.

PHTLS - Prehospital Trauma Life Support Practice Test

PHTLS - Prehospital Trauma Life Support Practice Test

PHTLS Traumatic Brain Injury 3