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Traumatic brain injury with herniation — ABEM Board MCQ

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HardTraumaTraumatic brain injury with herniationABEM Board

A 25-year-old man arrives after a fall from a roof. Triage acuity is ESI 1; BP 164/88 mm Hg, HR 48/min, RR 8/min and irregular. GCS is 6, left pupil is fixed and dilated, and he has extensor posturing. CT is not yet available because he is unstable. Which of the following is the most important immediate intervention?

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

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Correct answer: E — Intubate with cervical precautions and give hypertonic saline while elevating the head of bed

Severe TBI with signs of herniation requires airway control, prevention of hypoxia and hypotension, head elevation, and hyperosmolar therapy.

Reference: Brain Trauma Foundation severe TBI guidance; ATLS guidance