[Temp123]

I've been looking at a neuro case study where the patient has has a large intracranial bleed and develops bradycardia, decreased resps, widening pulse pressure and hypertension...

My immediate thought was Cushings Syndrome, due to another bleed and the increase in intracranial pressure... but could it be something else? Is it possible that ventricular drainage drained off too much and these are signs of tentorial herniation?

And if it is... what would you do?!?

[NurseyBaby'05]

Welcome to the board, Temp. I think you may be looking to deep into the scenario. What is the number one emergency you need to be on the lookout for with any head injury? You know it and said it, but I think you're looking to far into the scenario. What's the pt's LOC?

[tridil2000]

Originally Posted by Temp123

I've been looking at a neuro case study where the patient has has a large intracranial bleed and develops bradycardia, decreased resps, widening pulse pressure and hypertension...

My immediate thought was Cushings Syndrome, due to another bleed and the increase in intracranial pressure... but could it be something else? Is it possible that ventricular drainage drained off too much and these are signs of tentorial herniation?

And if it is... what would you do?!?

you present all the signs of ^ icp. the pt needs an icp monitor and yes, needs to go to the or to be opened up/pressure released.

where did you come up with cushings??

[Temp123]

Oh and Cushings Triad... not syndrome!

[cheat25]

Sounds like textbook herniation/cushing's syndrome. OF course, first assess the ICP if you have the ability to do that. In this situation, I would immediately perform nursing interventions to reduce ICP: head at midline and elevated, sedate, and if emergently necessary hyperventilate the patient until they can get to the OR. - cheat25