A 17 year old boy falls off a skateboard and hit his head on a rock wall and is knocked unconscious for ten minutes. Upon awakening he is neurologically intact but does not remember the accident. Several hours later, he develops a headache, vomits and develops right sided weakness. Mother brings him to ER. On exam BP 180/110 HR 50, RR 28 Mental status -- Lethargic but responsive. Motor -- Right hemiparesis. Reflexes bilateral plantar extensor responses (upgoing toes). Cranial nerves- left pupil is 8mm and poorly reactive to light; right pupil is 3 mm. What intervention does he need most urgently? hyperventilation IV steroids IV dextrose, thiamine, naloxone Drug to lower his BP
A 17 year old boy falls off a skateboard and hit his head on a rock wall and is knocked unconscious for ten minutes. Upon awakening he is neurologically intact but does not remember the accident. Several hours later, he develops a headache, vomits and develops right sided weakness. Mother brings him to ER. On exam BP 180/110 HR 50, RR 28 Mental status -- Lethargic but responsive. Motor -- Right hemiparesis. Reflexes bilateral plantar extensor responses (upgoing toes). Cranial nerves- left pupil is 8mm and poorly reactive to light; right pupil is 3 mm. What intervention does he need most urgently?
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hyperventilation |
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IV steroids |
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IV dextrose, thiamine, naloxone |
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Drug to lower his BP |
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