Which management steps are appropriate for increased intracranial pressure following head injury?

• A. Elevate head of bed, maintain adequate oxygenation, administer hyperosmolar therapy (hypertonic saline or mannitol), avoid hypotonic fluids, involve neurosurgery as needed
• B. Lower head of bed to improve drainage
• C. Induce hypotension
• D. Avoid neurosurgical consultation

Answer: (A)

Managing increased intracranial pressure after head injury focuses on reducing pressure while preserving blood flow to the brain. Elevating the head of the bed to about 30 degrees helps venous drainage from the brain, lowering ICP without compromising arterial inflow. Ensuring adequate oxygenation and ventilation prevents hypoxemia and hypercapnia, both of which can worsen cerebral edema and raise ICP. Hyperosmolar therapy, using hypertonic saline or mannitol, pulls water out of swollen brain tissue, providing rapid ICP reduction. Avoiding hypotonic IV fluids is important because they can worsen cerebral edema. If ICP remains elevated or there is a mass effect, involve neurosurgery for potential interventions such as decompression or hematoma evacuation. Lowering the head of the bed, inducing hypotension, or skipping neurosurgical input would not address ICP safely and can worsen outcomes.