What signs indicate increased intracranial pressure and what ED interventions help prevent herniation?

• A. Decreased LOC, vomiting, papilledema, unequal pupils, Cushing's triad; elevate head to 30 degrees, avoid hypotension, control ventilation to normocapnia (short-term hyperventilation for impending herniation), call neurosurgery; rapid imaging.
• B. Chest pain and tachycardia; give aspirin.
• C. Rash and itching; administer antihistamines.
• D. Hypoglycemia; administer glucose.

Answer: (A)

The signs point to increased intracranial pressure causing brain compression and risk of herniation, so the focus is on recognizing ICP and acting to lower it while organizing definitive care. Decreased level of consciousness, vomiting, papilledema, and unequal pupils reflect rising ICP and potential focal brain herniation, while Cushing’s triad—hypertension, bradycardia, and irregular respirations—signals brainstem involvement and impending herniation. In the ED, interventions aim to protect brain tissue and maintain perfusion: elevate the head of the bed to about 30 degrees to improve venous drainage and reduce ICP, avoid hypotension to preserve cerebral perfusion pressure, and manage ventilation to maintain normocapnia; if herniation is imminent, short-term hyperventilation can lower ICP by constricting cerebral vessels. Rapid imaging is essential to identify the cause and extent, and neurosurgery should be consulted for definitive management. The other scenarios describe chest pain with tachycardia, allergic symptoms, or hypoglycemia, which aren’t signs of ICP and are treated accordingly.