Acute Care

Question 1

If a child has a TBI and is initially alert, but then deteriorates, what do you suspect?

Answer 1

epidural hematoma

Question 2

What is a major cause of morbidity/mortality post-TBI?

Answer 2

disruption of autoregulatory mechanisms of the brain, resulting in inability to tolerate hypotension and ischemia

Question 3

signs of increased ICP

Answer 3

headache, decreased LOC, cushing’s triad (hypertension, bradycardia and irregular respirations), 6th or 3rd nerve palsy (eye down and out, dilated pupil)

Question 4

what is a chance fracture?

Answer 4

lap belt # of upper lumbar spine, often due to wearing lapbelt in MVC. high association with intrabdominal injuries.

Question 5

how do you manage a TCA overdose?

Answer 5

sodium bicarbonate, bolus 1-2 mEq/kg followed by continuous infusion IV

Question 6

what would concern you during a TCA overdose?

Answer 6

QRS widening (>100ms), hemodynamic instability

Question 7

management of increased ICP

Answer 7

• elevated head of bed to 30 degrees
• hyperventilation
• mannitol or hypertonic saline

Question 8

indications for CT imaging in TBI

Answer 8

LOC > 5 mins, dizziness, mental status changes, seizures, neurologic defects, skull fractor, drug or EtOH use, age < 2 yrs

Question 9

best inotrope for cold shock

Answer 9

dopamine, epinephrine

Question 10

best inotrope for warm shock

Answer 10

norepinephrine

Question 11

apnea test requirements

Answer 11

CO2 increase by 20 mmHg, AND above 60 mmHg AND pH <= 7.28

Question 12

pCO2 affected by

Answer 12

minute ventilation = rate x tidal volume

Question 13

pO2 affected by

Answer 13

mean airway pressure and FiO2