Severe traumatic brain injury — MCCQE Part 1 MCQ

Correct answer: C — Intubate/protect airway, prevent hypotension/hypoxia and obtain urgent CT/neurosurgical care

Intubate/protect airway, prevent hypotension/hypoxia and obtain urgent CT/neurosurgical care is best because low GCS and focal signs indicate severe TBI. Wait for confirmatory testing before any stabilisation is suboptimal because resuscitation and time-critical treatment should not wait when instability is present; Discharge once symptoms temporarily improve is suboptimal because temporary improvement can precede deterioration; Give an adjunctive medication as the sole first-line treatment is suboptimal because adjuncts do not replace definitive stabilisation; Delay escalation until cardiac arrest or respiratory failure occurs is suboptimal because early escalation is central to emergency care. Secondary brain injury prevention is immediate.

Reference: ATLS Canada principles