NREMT Paramedic Cognitive ExamTraumaHard
A 35-year-old male is found unconscious after being struck by a vehicle while riding his bicycle. He has a GCS of 6, unequal pupils, and decerebrate posturing. His blood pressure is 180/100 mmHg, heart rate 55 bpm, and respiratory rate 8 irregular breaths per minute. Which of the following is the MOST appropriate immediate intervention?
- AApply a cervical collar and rapidly extricate.
- BAdminister 100% oxygen via non-rebreather mask.
- CInitiate hyperventilation at a rate of 20 breaths per minute.
- DAdminister a 250 mL normal saline bolus.
Show answer & explanationAnswer & explanation
Correct answer: C. Initiate hyperventilation at a rate of 20 breaths per minute.
The patient presents with signs of severe traumatic brain injury (TBI) and impending brain herniation, indicated by unequal pupils, decerebrate posturing, and Cushing's triad (hypertension, bradycardia, irregular respirations). Hyperventilation temporarily reduces intracranial pressure (ICP) by causing cerebral vasoconstriction, which is a critical immediate intervention in this dire situation.
Why the other options are wrong
- A. Cervical immobilization is necessary, but managing the patient's severe TBI and impending herniation takes precedence for immediate life-saving intervention.
- B. While oxygen is important, hyperventilation directly addresses the impending brain herniation, which is the most immediate life threat.
- D. Fluid boluses can worsen cerebral edema in TBI; judicious fluid management is crucial to maintain normotension without fluid overload.
Hyperventilation in TBI
Controlled hyperventilation in severe traumatic brain injury (TBI) can temporarily reduce elevated intracranial pressure (ICP) by causing cerebral vasoconstriction.
- Used in severe TBI with signs of impending herniation.
- Causes cerebral vasoconstriction, reducing cerebral blood volume.
- Effect is temporary and must be used cautiously due to risk of cerebral ischemia.
Memory trick: Brain Crunch: Hyperventilate to avoid the Squish