Traumatic Brain Injury

Question 1

TBI guidelines recommendations for Sbp

Answer 1

≥ 100 mm Hg for 50 to 69 years

above 110 mm Hg for 70 years

Question 1

TBI is commonly graded in severity

Answer 1

mild (GCS ≥ 13), moderate (GCS 9– 12), or severe (GCS ≤ 8).

Question 2

Target Spo2 and partial pressure o2

Answer 2

Target oxygen saturation should be 94% or higher

partial pressure of oxygen > 70 mm Hg

Question 3

Hypocabnia vs hypocabnia

Answer 3

Hypercapnia causes vasodilation resulting in increased blood volume and intracranial pressure (ICP) elevation that can cause additional neuronal injury.

Hypocapnia > cerebral vasoconstriction and decreased cerebral blood flow (CBF), which can further exacerbate ischemic injury.

Question 4

recommended goal of Pco2

Answer 4

mild hyperventilation to maintain a pCO2 of 35 to 40 mm Hg.

Question 5

clinical signs of intracranial hypertension with concern for impending herniation

Answer 5

Cushing reflex or triad
increased blood pressure, bradycardia, and irregular respirations.

Question 6

Brainstem compression

Answer 6

posturing and Cheyne-Stokes ventilation (a cyclic breathing pattern marked by rapid deep breaths followed by a period of apnea)

Question 7

uncal herniation on the ipsilateral side

Answer 7

Unilateral pupil dilation and loss of light reactivity

Question 8

Alternative noninvasive measures of ICP include

Answer 8

transcranial Doppler and optic nerve sheath diameter monitors

Question 9

Define Intracranial hypertension, and CPP

Answer 9

ICP ≥ 20 mm Hg.

recent update supports interventions when ICP measures ≥ 22 mm Hg.

CPP = ICP - MAP
maintained between 60 and 70 mm Hg

Question 10

Factors that increase the risk of seizures in TBI

Answer 10

GCS ≤ 10,
loss of consciousness > 30 minutes,
immediate seizures
depressed skull fractures
penetrating injury
age 65 years or younger
and chronic alcoholism.

Question 11

Urgent surgical intervention is indicated in patients with at least one of the following:

Answer 11

midline shift greater than 5 mm
cisternal compression
elevated ICP refractory to medical management
low GCS score on presentation
and decline of clinical exam

Subdural hematomas thicker than 10 mm
epidural hematomas measuring 30 cm3,
and intraparenchymal lesions larger than 50 cm3

Question 12

fixation for Skull fracture is indicated for

Answer 12

open fractures, skull table displacement greater than 1 cm, gross deformity, or wound contamination

Question 13

neurostorming, hypothalamic dysregulation syndrome, paroxysmal sympathetic hyperactivity syndrome, and paroxysmal sympathetic storm ?

Answer 13

dysregulation of their autonomic system after injury.

β-blockers, specifically propranolol, in this early period can reduce mortality and significantly improve functional outcomes.

Question 14

declaring brain death

Answer 14

-irreversible coma
-no spontaneous respirations
-normothermia
-hemodynamic stability (SBP ≥ 100 mm Hg).
-sedating drugs, paralytics, and electrolytes or acid-base derangements excluded
-absence of brainstem reflexes
-pupillary light response; corneal, oculocephalic, and oculovestibular reflexes; no response to noxious stimuli; and the gag and cough reflexes induced with deep suctioning.

Question 15

apnea test

Answer 15

preoxygenated and normocapnic.
disconnected from the ventilator but provided oxygen.

The test is consistent with brain death if the final PaCO2 measures ≥ 60 mm Hg or if there is an increase of 20 mm Hg from baseline without evidence of spontaneous respirations.