In which of the following situations should iatrogenic hyperventilation be considered?
a. Severe traumatic brain injury
b. Initial treatment for increased intracranial pressure
c. Acute head injuries with increased intra-cranial pressure
d. Acute neurological deterioration with in-creased intracranial pressure
ANS: D
Hyperventilation may be needed for brief periods when acute neurological deterioration is pre-sent and the ICP is elevated. Current therapeutic guidelines for head injuries with increased ICP do not recommend prophylactic hyperventilation (PaCO2 < 25 mm Hg) during the first 24 hours. Hyperventilation during the first few days after severe traumatic brain injury (TBI) may actually increase cerebral ischemia and cause cerebral hypoxemia.
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