Blood
Braaaaaains
(Safe and legal) DRUGS!
#Trauma
100
Due to particularly limited excess space, bleeds in this part of of the brain are especially dangerous.
Posterior Fossa/Cerebellum.
May lead to cerebellar tonsilar herniation.
100
Describe cerebral perfusion pressure
Cerebral perfusion pressure is the difference between intracranial pressure and the MAP.
100
When giving Sedatives for RSI in a TBI, why should consideration be made to avoid hypotension?
Hypotension will reduce Cerebral perfusion pressure (especially if there is increased ICP), which can lead to anoxic brain injury and further neuro insult.
100
concussion discharge instructions? get 4
Unusual difficulty in awakening the patient at the expected time of waking
Severe or worsening headaches
Lethargy or confusion
Unsteadiness
Seizures
Visual changes or loss
Vomiting
Bowel/bladder dysfunction
Any focal neurological complaints
200
You are working at a Rural ER without any ability to transfer to a center with Nuerosurgery, and you have a patient with a large, expanding epidural. You might consider this as management?
Skull Trephination/Burr hole
200
Which one of the following (only one) is recommended in patients with TBI and concern for elevated ICP?
Hyperventilation
Intentional Cooling
Elevating head of Bed
Hyperoxegenation
Head of bed should be elevated. 20-35 degrees.
Hyperventilation for only short-term bridge to OR. otherwise normocapnia, normothermia (more important to keep afebrile) with O2~95%.
200
If you did want to reverse Clopidegrel in a intracranial hemorrhage, you would use this
PCC
200
Name 4 classic exam findings seen in Basilar skull Fractures
Racoon eyes, Battel Sign, CSF leak, hemotypanum
300
What BP will you typically see in TBI patients? How come?
Hypertensive. Usually the brain and neurovascular system are trying hard to increase perfusion to the brain. Often you are dealing with intractable hypertension. You should be concerned about hypotension.
300
Your patient is child who returns to the ED with a severe or progressive headache following a mild traumatic brain injury. Does this child need a head CT or not?
The guidelines recommended in favor of obtaining a CT with a clear statement that the risk of a delayed presentation of an intracranial injury outweighed the risk of radiation.
300
T/F: Ketamine can cause an increase in ICP and should be avoided for sedation in TBI if there is concern for intracranial bleed or elevated ICP
F
(This old belief was based a small case series from the 70's. A 2026 meta-analysis showed no ICP difference when using ketamine as sedative vs other sedative options)
300
Geriatric ground-level fall, don't forget to consult this specialty regardless of dispo!
Physical therapy. This can reduce fall-related return visits to the ED by 30% at 30 and 60 days. May be a sentinel event where one intervention can drastically alter course of life. therapy, supplies
400
What is the rate (%) of geriatric trauma patients that have an intracranial bleed?
5%
Some studies on 9-15%, another 5% regardless but if another present risk factor (e.g. CKD, GCS<15, head lac/bruising) does increase
400
Your patient with a known epidural hematoma has had a decrease of 3 points in GCS since presentation, and now has L sided mydraisis and downward deviation of the eye. What is going on?
(transtentorial/uncal) Herniation
400
What is the preferred drug to manage acute hypertension in a TBI patient?
Nicardipine or clevidipine.
You want to be able to titrate the agent and decrease pressure by vasodilating the arteries rather than affecting the cardiac output or venous dilation. Nicardipine does not affect the heart rate and you can give it to profoundly bradycardic patients. Nitroglycerin and nitroprusside shouldn’t be used because you want maximum preload. Labetalol is a negative inotrope.
400
Negative CT scan old lady on warfarin, what's the dispo?
Observe, strict return precautions, no repeat scans, risk of a delayed ICH after a normal initial head CT in anticoagulated older adults is very low (1-2%), and the majority of delayed bleeds do not require neurosurgical intervention
500
You've reversed anticoagulation, but your patient is also on antiplatelet therapy. What is your intervention?
The utility of desmopressin or platelet transfusions for patients on antiplatelet agents (eg, aspirin or clopidogrel) remains debatable without clear benefit. Reversal attempts appear to confer no mortality benefit in severe TBI patients on antiplatelet agents or Xa inhibitors.
500
Describe all criteria in the Nexus Head CT rule
Focal neurologic deficit present
Midline spinal tenderness present
Altered level of consciousness present
Intoxication present
Distracting injury present
Used to rule out cervical spine injury in alert, stable trauma patients without the need to obtain radiographic images. sensitivity of 99.6% for ruling out CSI
500
mannitol or hypertonic saline for ICP? Why?
COBI trial says equivalent. Some considerations (lytes, GFR) but many clinicians prefer HTS. Mannitol decreases intravascular volume, osmotic diuresis, can cause hypotension
500
So... what actually classifies a TBI as mild/minor?
clinical diagnosis either blunt trauma to the head or significant acceleration/deceleration injury, has a GCS score of 13-15 on medical presentation (or 30 minutes after injury), and one of the following:
Loss of consciousness (LOC) for <30 minutes
Amnesia regarding the event
Focal seizure
Other transient neurological findings