TBI TBI Acute Care & Emergency Management 2 — Questions and Answers
Question 1: The 'talk and die' phenomenon in TBI describes patients who:
- Appear neurologically intact initially then rapidly deteriorate due to expanding hematoma (Correct answer)
- Die while attempting to speak during intubation
- Have preserved speech centers despite severe motor deficits
- Experience fatal aspiration while talking after extubation
Correct answer: Appear neurologically intact initially then rapidly deteriorate due to expanding hematoma
The 'talk and die' phenomenon refers to patients who communicate normally after TBI but then rapidly deteriorate, classically due to an expanding epidural hematoma.
Question 2: Cushing's triad, indicating critically elevated intracranial pressure and impending herniation, consists of:
- Hypotension, tachycardia, and fever
- Hypertension, bradycardia, and irregular respirations (Correct answer)
- Hypotension, bradycardia, and apnea
- Hypertension, tachycardia, and hypothermia
Correct answer: Hypertension, bradycardia, and irregular respirations
Cushing's triad — hypertension (widened pulse pressure), bradycardia, and irregular respirations — signals brainstem compression and is a neurological emergency.
Question 3: What is the recommended approach to temperature management in acute severe TBI?
- Prophylactic induced hypothermia to 32°C for all patients
- Aggressive fever prevention; treat hyperthermia promptly (Correct answer)
- Permissive hyperthermia up to 39°C is acceptable
- Temperature management is not clinically significant in TBI
Correct answer: Aggressive fever prevention; treat hyperthermia promptly
While prophylactic hypothermia is not routinely recommended, fever above 38°C must be aggressively treated because hyperthermia significantly worsens secondary brain injury.
Question 4: What minimum systolic blood pressure must be maintained to prevent secondary injury in acute severe TBI, per Brain Trauma Foundation guidelines?
- 120 mmHg
- 90 mmHg (Correct answer)
- 70 mmHg
- 50 mmHg
Correct answer: 90 mmHg
The Brain Trauma Foundation identifies hypotension with SBP below 90 mmHg as a critical secondary insult that significantly worsens TBI outcomes.
Question 5: What is the primary mechanism by which mannitol reduces intracranial pressure in TBI?
- Reducing choroid plexus CSF production
- Creating an osmotic gradient that draws water from brain tissue into the vasculature (Correct answer)
- Blocking NMDA glutamate receptors to reduce excitotoxicity
- Inducing direct cerebral vasoconstriction
Correct answer: Creating an osmotic gradient that draws water from brain tissue into the vasculature
Mannitol reduces ICP primarily through its osmotic effect, establishing a gradient that pulls water from edematous brain tissue into the bloodstream for renal elimination.
Question 6: At what angle should the head of the bed be positioned for acute TBI patients to reduce ICP while preserving CPP?
- 0 degrees (completely flat)
- 15 degrees
- 30 degrees (Correct answer)
- 45 degrees
Correct answer: 30 degrees
Elevating the head of the bed to 30 degrees optimally promotes cerebral venous drainage to reduce ICP without significantly compromising cerebral perfusion pressure.
Question 7: At what GCS score is intubation for airway protection typically indicated in a TBI patient?
- GCS of 12 or below
- GCS of 10 or below
- GCS of 8 or below (Correct answer)
- GCS of 5 or below
Correct answer: GCS of 8 or below
A GCS of 8 or below indicates inability to adequately protect the airway and is the standard threshold for intubation in TBI management.
TBI TBI Acute Care & Emergency Management 2
The 'talk and die' phenomenon in TBI describes patients who: