TBI TBI Acute Care & Emergency Management 3

Question 1

Secondary brain injury in TBI is best defined as:

Accepted Answer

Cellular damage from ischemia, inflammation, and excitotoxicity that develops after the primary impact

Answer

Secondary brain injury encompasses the cascading cellular processes — including ischemia, excitotoxicity, and neuroinflammation — that occur hours to days after the initial trauma and are largely preventable.

Question 2

Decompressive craniectomy is indicated in severe TBI when:

Accepted Answer

ICP is refractory to maximal medical management

Answer

Decompressive craniectomy is a surgical last resort reserved for intracranial hypertension that is refractory to all medical therapies, creating space to relieve pressure.

Question 3

Why is hypoxia (SpO2 < 90%) particularly dangerous in acute TBI?

Accepted Answer

It exacerbates secondary brain injury and is independently associated with dramatically worse outcomes and mortality

Answer

Hypoxia in TBI directly worsens secondary brain injury by depriving vulnerable neurons of oxygen, and even a single hypoxic episode significantly increases morbidity and mortality.

Question 4

Which anticonvulsant(s) are recommended for prophylaxis of early post-traumatic seizures (within 7 days) in severe TBI?

Accepted Answer

Phenytoin or levetiracetam

Answer

Brain Trauma Foundation guidelines support phenytoin or levetiracetam for early seizure prophylaxis in the first 7 days after severe TBI to prevent seizures that worsen secondary injury.

Question 5

What type of intravenous fluid is preferred for resuscitation in acute TBI, and why?

Accepted Answer

Isotonic crystalloid (0.9% NaCl or lactated Ringer's) to maintain serum osmolality

Answer

Isotonic crystalloids are preferred because hypotonic solutions lower serum osmolality and worsen cerebral edema, while D5W and albumin have been associated with worse TBI outcomes.

TBI - Traumatic Brain Injury Certification Practice Test

TBI - Traumatic Brain Injury Certification Practice Test

TBI TBI Acute Care & Emergency Management 3