Pre-Quiz: TBI

A 42-year-old male patient with a past medical history of chronic back pain reports to the emergency department following an injury at a construction site. He describes falling approximately 20 feet onto rebar, incurring a profound puncture wound to his upper right extremity. The wound is presumed unclean. The patient’s medical record indicates that he is compliant with his vaccinations, and his last tetanus booster was administered 6 years ago.

Which one of the following statements about the patient’s tetanus immunization status is accurate?

A 45-year-old female is brought to the emergency department suffering from severe head trauma sustained in a high-speed car accident. She is unconscious upon arrival with a Glasgow Coma Scale (GCS) score of 8. Her vital signs are currently stable; however, her neurological examination suggests a deteriorating condition – unequal and sluggish pupils. A CT scan of her brain reveals a large intracerebral hematoma with signs of surrounding edema and midline shift. The neurosurgery team initiates continuous monitoring for intracranial pressure (ICP) to track the severity of her intracranial hypertension.

Based on this patient’s condition, what is the standard cutoff for defining intracranial hypertension?

An 18-year-old male with a past medical history of asthma is involved in a multi-vehicle collision and sustains multiple lower extremity open fractures with significant blood loss in the field. Upon arrival to the level one trauma center, massive transfusion protocol is initiated. Laboratory results reveal a normal ionized calcium level. In addition to blood products for resuscitation, what additional therapy should be initiated for this patient?

A two-year-old male is brought to the emergency department (ED) by his mother after she noticed him fall off the couch and onto the floor. She speculates that he fell approximately 2 feet. The fall was unwitnessed as she was in the other room when the incident occurred. The child seems to be behaving normally and exhibits no evident bruising or redness around the head or face. The ED physician employs an algorithm to determine whether a CT scan necessary. According to this criteria, this patient does not require a CT scan. What is the mentioned algorithm?

A 35-year-old male presents to the emergency department following a high-speed motor vehicle accident. He is unconscious, has a suspected spinal cord injury, and his vital signs are within normal limits except for a blood pressure of 165/95 mmHg. His past medical history is significant for hypertension and hyperlipidemia. A CT scan reveals a cervical spine fracture at the C5 level. According to the American Association of Neurological Surgeons and Congress of Neurological Surgeon, which one of the following is the recommended course of treatment for this patient’s spinal cord injury?