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Traumatic brain injury — DIPIMC MCQ

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HardPre-Hospital TraumaTraumatic brain injuryDIPIMCDipIMC

A 55-year-old has a severe head injury after a cycling collision and is being prepared for transfer to a neurosurgical centre. His GCS is 6 and he has been intubated. Which physiological derangement is most strongly associated with worse outcome and should be most actively prevented?

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Correct answer: E — A single episode of systolic blood pressure below 90 mmHg

Even a single episode of hypotension (systolic below 90 mmHg) markedly worsens outcome after traumatic brain injury by reducing cerebral perfusion, so avoiding hypotension and hypoxia is the central pre-hospital priority. Maintaining normocapnia and normothermia is appropriate, and a modestly raised pressure is far less harmful than hypotension. A glucose of 7 mmol/L is acceptable. Pearl: NICE recommends maintaining oxygenation and a systolic pressure of at least 110 mmHg in suspected significant head injury.

Reference: NICE NG232 (Head Injury); JRCALC Clinical Guidelines