Which treatment option is recommended for cerebral herniation?

• A. Administer normal saline 500 mL IV push
• B. Elevate head to 0 degrees
• C. Administer 250 mL of 3% or 5% hypertonic saline IV/IO bolus
• D. Hyperventilate to 40 breaths per minute

Answer: (C)

When cerebral herniation is suspected, the priority is to rapidly lower intracranial pressure and preserve cerebral perfusion. Administering a hypertonic saline bolus (250 mL of 3% or 5% solution) intravenously or via IO creates an osmotic gradient that draws fluid out of swollen brain tissue into the vascular space. This reduces brain edema and ICP quickly while also helping to maintain blood pressure to support cerebral perfusion.

The other options don’t address the edema directly or can worsen the situation. A normal saline bolus increases circulating volume but does not reduce brain swelling and can worsen intracranial pressure. Elevating the head to zero degrees doesn’t optimize venous drainage and is not the key intervention. Hyperventilating to a high rate can cause dangerous cerebral vasoconstriction, reducing cerebral blood flow and risking ischemia, and it’s not a first-line treatment for this condition.