The key components of secondary injury prevention in TBI include preventing which insults?

• A. Hypoxia, hypotension, fever, edema, seizures
• B. Hyperglycemia
• C. Hypothermia
• D. None of the above

Answer: (A)

Secondary injury after TBI is driven by events that occur after the initial insult, and preventing those insults helps limit further brain damage. The most important modifiable insults to prevent are hypoxia, which deprives the brain of oxygen and can worsen injury when blood flow is already compromised; hypotension, which lowers cerebral perfusion pressure and risks ischemia; fever, which raises metabolic demands and can amplify injury; edema, which increases intracranial pressure and reduces cerebral blood flow; and seizures, which cause excessive metabolic stress and excitotoxic injury. These are the common targets clinicians focus on to protect brain tissue in the acute period. While hyperglycemia and other factors are relevant to outcome, the set listed here represents the familiar bundle of secondary insults targeted for prevention, which is why this option is the best fit.