ATLS 134 Written Review Questions
What type of fluids should be used? - Correct Answer ✔️✔
️hypertonic (ringers lactate or normal saline). NO GLUCOSE.
What electrolyte abnormality is associated with brain edema and must
be monitored? - Correct Answer ✔️✔️hyponatremia
What are the physiologic consequences of PaCO2 >45?
PaCO2 <30? - Correct Answer ✔️✔️f PaCO2 >45 = vasodilation =
inc ICP
PaCO2 <30 (hyperventilation) = constriction = ischemia
What is the preferred PaCO2 in brain injury? - Correct Answer ✔️
✔️35 mm Hg
If ICP is rapidly increasing, what can be done while preparing for
craniotomy? - Correct Answer ✔️✔️hyperventilation. NOTE: this
must be monitored closely and is only done very short periods at a time
,Does hypertonic saline lower ICP in hypovolemia?
Does mannitol lower ICP in hypovolemia? - Correct Answer ✔️✔
️No
NO
After administration of mannitol what should be monitored closely? -
Correct Answer ✔️✔️ICP! mannitol has a substantial rebound
effect on ICP
What is the role of muscle relaxants (vecuronium or succinylcholine) in
seizures with TBI? - Correct Answer ✔️✔️NONE.
these may mask tonic-clonic seizures and prevent anticonvulsant
intervention (30-60 min of seizure = secondary brain injury)
What meningeal tear would a CSF leakage of a head laceration
indicate? - Correct Answer ✔️✔️dural tear
,What is the treatment of any intracranial mass lesion? - Correct
Answer ✔️✔️Must be evacuated by neurosurgeon. transfer if not
available.
for a penetrating object such as an arrow or screw driver into the skull,
test should be performed and what should be done with the object? -
Correct Answer ✔️✔️need CT, Xray for trajectory, and
angiography. leave the object in place. Removing the object lead to
fatal vascular injury.
What clinical signs are the criteria for brain death? - Correct Answer
✔️✔️GCS of 3, nonreactive pupil, absent brainstem reflexes, no
spontaneous ventilatory effort
Which vertebrae is most susceptible to injury? - Correct Answer ✔️
✔️Cervical.
NOTE: in peds this accounts for only 1% of vertebral injury
, What nerve and cervical spine level would cause apnea and results in
death in 1/3 of patient with upper cervical spine injury - Correct
Answer ✔️✔️phrenic nerve
C1
At what age do cervical spine differences begin to normalize? at what
age does cervical spine look like that of an adult? - Correct Answer ✔
️✔️marked differences in cervical spine occur until age 8 and
steadily decline until age 12 when they are similar
When a dislocation-fracture of the vertebrae occurs, almost always the
result is _____. - Correct Answer ✔️✔️complete spinal cord
injury
T/F: the thoracolumbar junction is extremely strong and rarely incurs
injury? - Correct Answer ✔️✔️FALSE: the flexible thoracic
meeting the rigid lumbar make this area a common place for injury
(15% of all spinal injuries)
What type of fluids should be used? - Correct Answer ✔️✔
️hypertonic (ringers lactate or normal saline). NO GLUCOSE.
What electrolyte abnormality is associated with brain edema and must
be monitored? - Correct Answer ✔️✔️hyponatremia
What are the physiologic consequences of PaCO2 >45?
PaCO2 <30? - Correct Answer ✔️✔️f PaCO2 >45 = vasodilation =
inc ICP
PaCO2 <30 (hyperventilation) = constriction = ischemia
What is the preferred PaCO2 in brain injury? - Correct Answer ✔️
✔️35 mm Hg
If ICP is rapidly increasing, what can be done while preparing for
craniotomy? - Correct Answer ✔️✔️hyperventilation. NOTE: this
must be monitored closely and is only done very short periods at a time
,Does hypertonic saline lower ICP in hypovolemia?
Does mannitol lower ICP in hypovolemia? - Correct Answer ✔️✔
️No
NO
After administration of mannitol what should be monitored closely? -
Correct Answer ✔️✔️ICP! mannitol has a substantial rebound
effect on ICP
What is the role of muscle relaxants (vecuronium or succinylcholine) in
seizures with TBI? - Correct Answer ✔️✔️NONE.
these may mask tonic-clonic seizures and prevent anticonvulsant
intervention (30-60 min of seizure = secondary brain injury)
What meningeal tear would a CSF leakage of a head laceration
indicate? - Correct Answer ✔️✔️dural tear
,What is the treatment of any intracranial mass lesion? - Correct
Answer ✔️✔️Must be evacuated by neurosurgeon. transfer if not
available.
for a penetrating object such as an arrow or screw driver into the skull,
test should be performed and what should be done with the object? -
Correct Answer ✔️✔️need CT, Xray for trajectory, and
angiography. leave the object in place. Removing the object lead to
fatal vascular injury.
What clinical signs are the criteria for brain death? - Correct Answer
✔️✔️GCS of 3, nonreactive pupil, absent brainstem reflexes, no
spontaneous ventilatory effort
Which vertebrae is most susceptible to injury? - Correct Answer ✔️
✔️Cervical.
NOTE: in peds this accounts for only 1% of vertebral injury
, What nerve and cervical spine level would cause apnea and results in
death in 1/3 of patient with upper cervical spine injury - Correct
Answer ✔️✔️phrenic nerve
C1
At what age do cervical spine differences begin to normalize? at what
age does cervical spine look like that of an adult? - Correct Answer ✔
️✔️marked differences in cervical spine occur until age 8 and
steadily decline until age 12 when they are similar
When a dislocation-fracture of the vertebrae occurs, almost always the
result is _____. - Correct Answer ✔️✔️complete spinal cord
injury
T/F: the thoracolumbar junction is extremely strong and rarely incurs
injury? - Correct Answer ✔️✔️FALSE: the flexible thoracic
meeting the rigid lumbar make this area a common place for injury
(15% of all spinal injuries)
