Question

A seven-year-old boy is involved in a rollover motor vehicle collision. He arrives intubated by the paramedic service. On exam, you note him to be flexing both upper extremities. Which of the following is the most sensitive indicator of herniation?

A) Bradycardia
B) Hypertension
C) Hypotension
D) Irregular respiration

Answer 1

Irregular respiration is the most sensitive indicator of herniation in a patient who is post-motor vehicle collision and shows neurological symptoms, as it may suggest medullary compression.

Step-by-step explanation:

The most sensitive indicator of herniation in the scenario described—a seven-year-old boy flexing both upper extremities after a rollover collision—is Irregular respiration.

The presentation of bradycardia, hypertension, hypotension, and irregular respiration are all part of the Cushing reflex, which indicates raised intracranial pressure and potential brain herniation.

Of these, irregular respiration is concerning for medullary compression due to herniation, often preceding cardiovascular changes.