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 A question for the group:
A 15 y old boy arrived to the ED 20 minutes after falling from a ladder (approximately 2m height). There was no LOC. On arrival to the ED – GCS 15, normal vitals, no focal neurological signs (walking,  talking with the nurse). Large open depressed temporal skull fracture.  5 minutes after arrival – seizures, treated with midazolam, the seizures stopped, intubated (RSI).  HR 110, BP 130/80 pupils equal and reactive. 
Would you treat with hypertonic saline/mannitol at this point?  (CT is immediately available for this patient)
Thanks
Eran

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