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Traumatic brain injury transfer optimisation — DipIMC MCQ

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HardRetrieval MedicineTraumatic brain injury transfer optimisationDipIMC

A 33-year-old man with severe traumatic brain injury is packaged for a 40-minute road transfer. His oxygen saturation is 97%, systolic pressure is 86 mmHg and end-tidal CO2 is rising. What is the most appropriate immediate action?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Correct hypotension and ventilation problems before leaving if this will not cause harmful delay

In traumatic brain injury, hypoxia, hypotension and deranged ventilation cause secondary brain injury and should be corrected promptly. Permissive hypotension is not appropriate when cerebral perfusion is threatened. Aggressive hyperventilation can reduce cerebral blood flow unless used briefly for impending herniation. The pearl is that packaging should include physiological optimisation, not just straps and blankets.

Reference: NICE Major Trauma NG39; JRCALC Guidelines 2025