Immediate management

There is no clear benefit from

• hyperventilation  ^d
• CSF drainage  ^d
• steroids  ^d
• barbiturates  ^d
• mannitol  ^d
• hypertonic saline   ^d

Why?

• None of these treatments are clearly better than no intervention at reducing mortality.  Steroids in particular have no significant effect on death or disability. ^d
• Hypertonic saline is not clearly better than Ringer's lactate at reducing neurological problems. ^d