Two classic signs of increased ICP: - Hypertension - Bradycardia (Cushing’s reflex) Expected signs of brain herniation: - Unequal pupils - Posturing - Irregular respirations (Cheyne stokes or Biots/Ataxic) - Rapid decline in mental status Treatment for ICP (prehospital): - Hyperventilation ONLY if signs of herniation (get EtCO2 to 35-40) - Mannitol is NOT used in EMS unless critical care - 1g/kg over 10min for edema, not blood.

Which finding suggests a retroperitoneal hemorrhage after blunt trauma?

A hiker lands feet first after jumping from a height, injuring the underside of his foot. Which anatomical term describes the injured area?

You arrive at the scene where a 5-year-old boy fell off a jungle gym. His forearm near the wrist is swollen, tender, and visibly deformed. Distal circulation and sensation are intact. Which term best describes the location of this fracture?

1️⃣ It lowers cerebral perfusion pressure (CPP). CPP = MAP – ICP When you sit a patient straight up (60–90°): - Blood drains out of the brain too quickly - MAP drops - This causes CPP to fall, meaning less oxygen and blood reach the brain Patients with increased ICP are already at risk of brain ischemia → high Fowler’s makes this worse. 2️⃣ It can decrease venous return too much. High Fowler’s: - Reduces central venous pressure - Reduces preload - Can cause a drop in cardiac output - Which again → lowers CPP The brain needs stable blood flow, not sudden drops. 3️⃣ The recommended position is instead 30° (semi-Fowler’s). This is the sweet spot: - Promotes venous drainage from the brain - Reduces ICP - Does NOT significantly lower MAP or CPP This is why nearly all trauma/neuro guidelines recommend: Head of bed elevated 30°, head midline, spine neutral. ⚠️ High Fowler’s may be harmful if the patient is hypotensive. In trauma, TBI, or shock: - Sitting upright worsens hypotension - Hypotension + ICP = catastrophic drop in CPP - CPP < 60 mmHg → brain ischemia and secondary injury