Head trauma with suspected intracranial pressure elevation: which intervention is essential to start with?

• A. Airway protection
• B. Elevate HOB
• C. Administer mannitol immediately
• D. Aggressive diuresis

Answer: (A)

Securing the airway is the most essential first step. In head trauma with suspected elevated intracranial pressure, hypoxia and elevated CO2 worsen cerebral edema and can drive herniation. By protecting the airway and establishing controlled ventilation, you ensure adequate oxygen delivery to the brain and maintain normocapnia or carefully managed CO2 levels, which helps limit secondary brain injury.

Elevating the head of the bed is helpful for reducing ICP, but it doesn’t address the critical need to oxygenate and ventilate the patient. Administering mannitol or other osmotic agents is a recognized ICP intervention, yet it relies on having a secured airway and reliable ventilation first; giving it without airway control risks inadequate delivery, monitoring challenges, and potential complications. Aggressive diuresis isn’t appropriate as the initial action and isn’t a substitute for airway management.