What is the initial priority in a patient with suspected increased intracranial pressure?

• A. Administer high-dose steroids immediately
• B. Place patient flat and immobile
• C. Ensure airway, breathing, and circulation; elevate head to 30 degrees; avoid neck flexion to prevent ICP rise
• D. Induce rapid cooling to reduce metabolic demand

Answer: (C)

The core idea is to stabilize the patient by protecting the airway and ensuring adequate ventilation and perfusion, then optimize venous drainage from the brain. Securing the airway and supporting breathing and circulation prevents hypoxia and hypotension, both of which worsen brain injury and can raise intracranial pressure. After that, position the head to promote drainage: elevate the head about 30 degrees and keep the head and neck in a neutral, midline position to avoid jugular venous compression or flexion, which can raise ICP. This combination helps reduce intracranial pressure while maintaining cerebral perfusion.

Steroids are not an immediate intervention for suspected ICP because they do not reliably lower ICP and can cause harmful side effects. Rapid cooling is not a standard initial measure for ICP; it carries risks and does not address the immediate need to secure airway and optimize venous outflow.