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Resuscitation with head injury — DIPIMC MCQ

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HardPre-Hospital TraumaResuscitation with head injuryDIPIMCDipIMC

A polytrauma patient has both a suspected significant head injury and uncontrolled torso haemorrhage with a thready pulse. You have blood products. The competing priorities are limiting blood loss and maintaining cerebral perfusion. Which fluid strategy is most appropriate?

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

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Correct answer: B — Blood products titrated to a higher pressure target than usual to protect the injured brain

When significant traumatic brain injury coexists with haemorrhage, the usual permissive hypotension is modified upward, using blood products to maintain a higher pressure (a systolic of at least 110 mmHg) to preserve cerebral perfusion while still avoiding over-resuscitation. Strict permissive hypotension risks secondary brain injury, while crystalloid loading and high-dose vasopressors are not preferred. Withholding fluid is inappropriate with brain injury. Pearl: the brain tolerates hypotension poorly, so the haemorrhage target is raised when head injury is suspected.

Reference: NICE NG39 (Major Trauma); NICE NG232 (Head Injury)