Acute transtentorial herniation pattern
Educational use only. Not clinically reviewed58-year-old man for calm first-hour herniation recognition, rescue-boundary, and handoff practice. About 6 simulated minutes.
What you will practise
- Reconcile the consciousness, pupil, motor, respiratory, circulatory, structural, and whole-patient clock.
- Recognize a converging transtentorial herniation pattern without relying on an isolated pupil or complete Cushing triad.
- Activate qualified airway, neurocritical, neurosurgical, and brain-rescue ownership immediately.
- Review the immediate systemic brain-rescue, imaging, and definitive source-control boundary.
- At a strict later report, review qualified rescue and the unresolved neurological trajectory.
- After another elapsed interval, hand off lesion, airway, pressure, seizure, surgery, and active risk.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- Neurocritical Care Society. Emergency Neurological Life Support: Intracranial Hypertension and Herniation Protocol. Version 6.0. 2026.
- Stevens RD, Shoykhet M, Cadena R. Emergency Neurological Life Support: Intracranial Hypertension and Herniation. Neurocrit Care. 2015;23 Suppl 2:S76-S82. doi:10.1007/s12028-015-0168-z.
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.