Goal: Prevent secondary brain injury by maintaining adequate oxygenation and ventilation, avoiding hypotension, observing for signs and symptoms of elevated ICP, and trending the response to resuscitation. Detect changes in vital signs and neurologic examination as early as possible.

Assessment  and  Monitoring  Notes

Cushing’s triad (i.e., increased SBP and/or widening pulse pressure, bradycardia, and irregular respirations) is a physiologic response that can occur with elevated ICPs, resulting in medullary compression. It is a late finding of severe brain injury with brainstem herniation. Cushing’s triad should be viewed as a sign of cerebral herniation and addressed immediately when recognized (see ICP Management).