ATLS Module 6 Head trauma test quiz
with correct answers
48 yo falls from balcony. she was witnessed striking her head on steps after ~8 foot fall. Pt
breifly lost consciousness and is found confused, lying at the bottom of the steps. Her eyes are
open, and she is rubbing her forehead. The most important finding related to pt's long term
outcome is: - CORRECT ANSWERS-GCS score
*GCS is accurate measure of CNS fx and can be followed over time
78 yo male is found down in bathroom with large left scalp laceration from strinking the corner of
the sink. He arrives in ED with BP 180/90, HR 60, and a dilated, non-responsive right pupil.
what is the most likely finding on this pt's CT scan? - CORRECT ANSWERS-subdural
hematoma with midline shift
*PE findings point to impending uncal herniation... the blown pupil is evidence of mass effect in
intracranial vault
81 yo female arrives in ED after a fall from standing. The only visible sign of injury is a large
scalp laceration. Paramedics report that she has been getting pregressively hypotensive over
the past 20 mins. They infused 2L of normal saline, now BP is 135/70. She is somnolent, but
can be aroused. There is some hemorrhage from a large 20 cm scalp laceration. Which of the
following is next step in managing pt?
a. order CT of head
b. infuse 2 units of packed RBCs
c. repair laceration
d. transfer pt to trauma center - CORRECT ANSWERS-c.
scalp lacs are vascular injuries that can result in major blood loss capable of hemorrhagic
shock. stopping outwars signs of hemorrhage will avoid further hypotension
A CT scan reveals diffuse intracranial hemorrhage and swelling with collapse of 3rd & 4th
ventricles and impending uncal herniation. Which of the following tx measures is not an
appropriate initial intervention?
, A. mannitol (.25-1mg/kg bolus)
B. hypertonic saline bolus
C. Phenytoin (1g IV loading dose)
D. Decompressive craniotomy - CORRECT ANSWERS-D. decompressive craniotomy
*data suggests that outcomes from diffuse intracranial swelling are not improved with
decompressive craniotomy
acute seizures can be controlled with anticonvulsants, so why should anticonvulsants be used
only when absolutely necessary? - CORRECT ANSWERS-anticonvulsants can inhibit brain
recovery
*red text*
after managing ABCDEs in a pt with head trauma and neurosurgical capabilities exist at your
hospital, what do you do> - CORRECT ANSWERS-it is critical to identify any mass lesion
requiring surgical evacuation... this is best achieved via CT scan of head
can intracranial hemorrhage cause hemorrhagic shock? - CORRECT ANSWERS-no
cerebral blood vessels can contrict or dilate in response to changes in partial pressure of
oxygen and parial pressure of CO2... therefore, what could cause secondary injury via this
mechanism? - CORRECT ANSWERS-hypotension, hypoxia, hypercapnia, iatrogenic
hypocapnia
comatose pts should be intubated early... they should be ventilated with 100% oxygen until
blood gas measurements are obtained. what are desirable pulse ox saturation? - CORRECT
ANSWERS->98%
PCO2 ~ 35mmHg
how does hypercarbia affect the brain? - CORRECT ANSWERS-PCO2 >45 will promote
vasodilation and increase intracranial pressure
how does hyperventilation affect the brain? - CORRECT ANSWERS-hyperventilation reduces
PaCO2 and causes cerebral vasoconstriction
with correct answers
48 yo falls from balcony. she was witnessed striking her head on steps after ~8 foot fall. Pt
breifly lost consciousness and is found confused, lying at the bottom of the steps. Her eyes are
open, and she is rubbing her forehead. The most important finding related to pt's long term
outcome is: - CORRECT ANSWERS-GCS score
*GCS is accurate measure of CNS fx and can be followed over time
78 yo male is found down in bathroom with large left scalp laceration from strinking the corner of
the sink. He arrives in ED with BP 180/90, HR 60, and a dilated, non-responsive right pupil.
what is the most likely finding on this pt's CT scan? - CORRECT ANSWERS-subdural
hematoma with midline shift
*PE findings point to impending uncal herniation... the blown pupil is evidence of mass effect in
intracranial vault
81 yo female arrives in ED after a fall from standing. The only visible sign of injury is a large
scalp laceration. Paramedics report that she has been getting pregressively hypotensive over
the past 20 mins. They infused 2L of normal saline, now BP is 135/70. She is somnolent, but
can be aroused. There is some hemorrhage from a large 20 cm scalp laceration. Which of the
following is next step in managing pt?
a. order CT of head
b. infuse 2 units of packed RBCs
c. repair laceration
d. transfer pt to trauma center - CORRECT ANSWERS-c.
scalp lacs are vascular injuries that can result in major blood loss capable of hemorrhagic
shock. stopping outwars signs of hemorrhage will avoid further hypotension
A CT scan reveals diffuse intracranial hemorrhage and swelling with collapse of 3rd & 4th
ventricles and impending uncal herniation. Which of the following tx measures is not an
appropriate initial intervention?
, A. mannitol (.25-1mg/kg bolus)
B. hypertonic saline bolus
C. Phenytoin (1g IV loading dose)
D. Decompressive craniotomy - CORRECT ANSWERS-D. decompressive craniotomy
*data suggests that outcomes from diffuse intracranial swelling are not improved with
decompressive craniotomy
acute seizures can be controlled with anticonvulsants, so why should anticonvulsants be used
only when absolutely necessary? - CORRECT ANSWERS-anticonvulsants can inhibit brain
recovery
*red text*
after managing ABCDEs in a pt with head trauma and neurosurgical capabilities exist at your
hospital, what do you do> - CORRECT ANSWERS-it is critical to identify any mass lesion
requiring surgical evacuation... this is best achieved via CT scan of head
can intracranial hemorrhage cause hemorrhagic shock? - CORRECT ANSWERS-no
cerebral blood vessels can contrict or dilate in response to changes in partial pressure of
oxygen and parial pressure of CO2... therefore, what could cause secondary injury via this
mechanism? - CORRECT ANSWERS-hypotension, hypoxia, hypercapnia, iatrogenic
hypocapnia
comatose pts should be intubated early... they should be ventilated with 100% oxygen until
blood gas measurements are obtained. what are desirable pulse ox saturation? - CORRECT
ANSWERS->98%
PCO2 ~ 35mmHg
how does hypercarbia affect the brain? - CORRECT ANSWERS-PCO2 >45 will promote
vasodilation and increase intracranial pressure
how does hyperventilation affect the brain? - CORRECT ANSWERS-hyperventilation reduces
PaCO2 and causes cerebral vasoconstriction
