Head Trauma

Question 1

Should obtaining a CT scan delay transferring a patient to a hospital with definitive neurosurgical management?

Answer 1

No

Question 2

Ipsilateral pupillary dilation and contralateral paralysis is associated with what herniation syndrome?

Answer 2

Uncal herniation

Question 3

What is the GCS score defining coma?

Answer 3

8 or less

Question 4

Why should you not underestimate the presence of a skull fracture?

Answer 4

It takes considerable energy and trauma to fracture the skull

Question 5

What types of sedative and analgesic meds should be used in patients with head injury?

Answer 5

Those with shorter half-lives and duration

Question 6

What is generally the threshold for midline shift before operative intervention?

Answer 6

5mm

Question 7

Should mannitol be given to a hypovolemic patient?

Answer 7

No, it may cause a further loss of volume and additional deterioration

Question 8

Are antiepileptics recommended in the brain injured patient?

Answer 8

If the patient is actively seizing then yes but the early use of AEDs as a prophylactic measure does not change long-term traumatic seizure outcome

Question 9

What are brain death criteria?

Answer 9

GCS = 3
Absent brainstem reflexes (no corneal, doll’s head, cold water calorics, gag reflex)
Fixed, dilated, nonreactive pupils
No spontaneous ventilatory effort on formal apnea testing