A nurse notes that a patient with a traumatic brain injury is having a rapid decline in level of consciousness. If the nurse suspects cerebral herniation the most appropriate intervention would be to:
1. Briefly hyperventilate the patient.
2. Take measures to increase intracranial pressures by Trendelenburg positioning.
3. Prepare for emergency surgical repair.
4. Contact the family to come say their last words with the patient.
1
Rationale 1: Hyperventilating the patient lowers the ICP by lowering the PaCO2 that is causing vasoconstriction of the cerebral blood vessels and reducing cerebral blood flow.
Rationale 2: This position places the patient at greater risk of permanent damage from decreased cerebral blood flow.
Rationale 3: Emergency surgery might be needed but hyperventilating the patient will temporarily allow more time for informed decision making.
Rationale 4: Although this may be a life and death event, the activity that might reduce this risk can be temporarily avoided by hyperventilation first.
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