TBI TBI Acute Care & Emergency Management 1 — Questions and Answers
Question 1: What is the primary goal of acute TBI management in the emergency setting?
- Prevent secondary brain injury (Correct answer)
- Restore consciousness immediately
- Administer sedative medications
- Perform immediate surgical intervention
Correct answer: Prevent secondary brain injury
The primary goal is to prevent secondary brain injury by maintaining adequate oxygenation, perfusion, and controlling intracranial pressure.
Question 2: A Glasgow Coma Scale (GCS) score at or below which value indicates severe traumatic brain injury?
- 12
- 10
- 8 (Correct answer)
- 6
Correct answer: 8
A GCS score of 8 or below indicates severe TBI, requiring aggressive management including airway protection and ICP monitoring.
Question 3: According to Brain Trauma Foundation guidelines, what is the target intracranial pressure (ICP) in acute severe TBI management?
- Less than 5 mmHg
- Less than 20-22 mmHg (Correct answer)
- Less than 30 mmHg
- Less than 40 mmHg
Correct answer: Less than 20-22 mmHg
Current Brain Trauma Foundation guidelines recommend maintaining ICP below 20-22 mmHg to prevent herniation and secondary brain injury.
Question 4: Which intervention is considered a simple first-line measure for reducing elevated ICP in acute TBI?
- Immediate surgical decompression
- Head-of-bed elevation to 30 degrees (Correct answer)
- Administration of broad-spectrum antibiotics
- Emergency lumbar puncture
Correct answer: Head-of-bed elevation to 30 degrees
Elevating the head of the bed to 30 degrees promotes cerebral venous drainage and reduces ICP without significantly compromising CPP.
Question 5: According to Brain Trauma Foundation guidelines, what is the recommended cerebral perfusion pressure (CPP) target in adult severe TBI?
- 40-50 mmHg
- 60-70 mmHg (Correct answer)
- 80-90 mmHg
- 100-110 mmHg
Correct answer: 60-70 mmHg
The Brain Trauma Foundation recommends a CPP target of 60-70 mmHg to ensure adequate cerebral perfusion without causing excessive cerebral blood flow.
Question 6: What is the primary mechanism by which brief hyperventilation temporarily reduces ICP in acute TBI?
- Increases oxygen delivery to ischemic neurons
- Causes cerebral vasoconstriction by lowering PaCO2 (Correct answer)
- Prevents pulmonary edema from developing
- Improves cardiac output and MAP
Correct answer: Causes cerebral vasoconstriction by lowering PaCO2
Hyperventilation lowers PaCO2, which causes cerebral vasoconstriction, reducing cerebral blood volume and transiently decreasing ICP.
Question 7: Which imaging modality is the gold standard for initial evaluation of acute traumatic brain injury in the emergency department?
- MRI of the brain with contrast
- Non-contrast CT scan of the head (Correct answer)
- PET scan of cerebral metabolism
- EEG for cortical activity
Correct answer: Non-contrast CT scan of the head
Non-contrast CT is the gold standard because it is fast, widely available, and reliably identifies hemorrhage, skull fractures, and mass effect.
TBI TBI Acute Care & Emergency Management 1
What is the primary goal of acute TBI management in the emergency setting?