Free BCEN Certified Flight Registered Nurse (CFRN) Practice Question

The most immediate management priority for patients with significant midline shift due to a space-occupying lesion, such as intraparenchymal hemorrhage, is to ensure adequate oxygenation and ventilation, as increased intracranial pressure (ICP) can compromise respiratory function. Hyperventilation can help reduce ICP by causing cerebral vasoconstriction. Ensuring airway patency and oxygenation are critical during transport to prevent secondary brain injury. While monitoring blood pressure and administering osmotic diuretics are important, ensuring adequate ventilation takes precedence to avoid further hypoxia or hypercapnia which can exacerbate neurological deterioration.