After striking his head on a tree while falling from a ladder, a young man age 18 is admitted to the emergency department.
He’s unconscious and his pupils are nonreactive. Which intervention would be the most dangerous for the client?
- a- Give him a barbiturate.
- b- Place him on mechanical ventilation.
- c- Perform a lumbar puncture.
- d- Elevate the head of his bed.
Answer C.
The client’s history and assessment suggest that he may have increased intracranial pressure (ICP).If this is the case, lumbar puncture shouldn’t be done because it can quickly decompress the central nervous system and, thereby, cause additional damage.
After a head injury, barbiturates may be given to prevent seizures; mechanical ventilation may be required if breathing deteriorates; and elevating the head of the bed may be used to reduce ICP.
In the given scenario, the most dangerous intervention for the client would be option C: Perform a lumbar puncture.
A lumbar puncture, also known as a spinal tap, involves inserting a needle into the spinal canal to collect cerebrospinal fluid (CSF) for diagnostic purposes. Performing a lumbar puncture in a patient with an unconscious state and nonreactive pupils, following head trauma, can be potentially harmful. It poses a risk of brain herniation, which is the displacement of brain tissue due to increased intracranial pressure. Brain herniation can be life-threatening and can lead to severe neurological damage or death.
The other options can be evaluated as follows:
a) Giving a barbiturate:
Barbiturates are central nervous system depressants that can lower intracranial pressure. However, their administration should be based on careful evaluation and monitoring of the patient's condition. Without further information, it is not possible to determine if this intervention is appropriate or safe.
b) Placing the patient on mechanical ventilation:
This intervention can be beneficial for maintaining proper oxygenation and ventilation, which is crucial in a patient with an unconscious state. Mechanical ventilation can help support the patient's respiratory function while other necessary interventions are performed.
d) Elevating the head of the bed:
Elevating the head of the bed to approximately 30 degrees is a standard practice in managing patients with suspected or confirmed traumatic brain injury. It helps optimize cerebral venous drainage and reduce intracranial pressure.
It is important to note that in a real-life emergency situation, a comprehensive evaluation of the patient's condition and consultation with a healthcare professional would be necessary to determine the most appropriate interventions based on the individual's specific circumstances.
