Which vital signs pattern on admission indicates Cushing's triad and potentially impending brain herniation?

Which vital signs pattern on admission indicates Cushing's triad and potentially impending brain herniation?

• A. 130/72, pulse 90, respirations 32
• B. 148/78, pulse 112, respirations 28
• C. 156/60, pulse 60, respirations 14
• D. 110/70, pulse 120, respirations 30

Answer: (C)

The pattern being tested is recognizing Cushing's triad, a sign of rising intracranial pressure and potential brain herniation. Cushing's triad consists of hypertension with a wide pulse pressure, bradycardia, and abnormal or slowed respirations. In this scenario, the vitals show a markedly elevated systolic pressure with relatively low diastolic pressure, producing a wide pulse pressure; the heart rate is slow (bradycardia); and the breathing rate is slower-than-normal (bradypnea or irregular respirations). This combination is classic for increased ICP and impending herniation, requiring urgent Neuro ICU evaluation and management. Other patterns—such as normal or moderate blood pressure with tachycardia and/or tachypnea—do not fit this triad and do not indicate the same level of ICP concern.

The pattern being tested is recognizing Cushing's triad, a sign of rising intracranial pressure and potential brain herniation. Cushing's triad consists of hypertension with a wide pulse pressure, bradycardia, and abnormal or slowed respirations. In this scenario, the vitals show a markedly elevated systolic pressure with relatively low diastolic pressure, producing a wide pulse pressure; the heart rate is slow (bradycardia); and the breathing rate is slower-than-normal (bradypnea or irregular respirations). This combination is classic for increased ICP and impending herniation, requiring urgent Neuro ICU evaluation and management.

Other patterns—such as normal or moderate blood pressure with tachycardia and/or tachypnea—do not fit this triad and do not indicate the same level of ICP concern.