Raised intracranial pressure

Paediatric emergency management · Neuroprotection · Neurology

Suspect with falling GCS, unequal/sluggish pupils, Cushing's response (hypertension, bradycardia, irregular breathing) or posturing.

General neuroprotection

• Head midline, elevated 15–30°; ensure oxygenation and normocapnia; treat pain, fever and seizures.
• Maintain normal blood pressure to preserve cerebral perfusion; avoid hypotension and hypoglycaemia.

Acute herniation

• Hyperosmolar therapy: hypertonic saline 3% (3–5 mL/kg) or mannitol 0.25–0.5 g/kg.
• Brief controlled hyperventilation only as a bridge to definitive treatment; urgent imaging and neurosurgical referral.