Pressured Priya — Increased Intracranial Pressure
Cushing's triad is late — act on the early changes
Priya's skull cannot expand, so every milliliter of swelling has to push something out. Long before her vital signs change, the first thing to go is the way she answers a simple question.
Priya's brain swells inside a closed box. The earliest sign is a change in level of consciousness, not the vital signs. Head midline and elevated 30 degrees, avoid anything that raises pressure, and treat with hypertonic saline or mannitol.
Read Pressured Priya's full story →The story arc
The setup
A fall down stairs causes a subdural hematoma that bleeds slowly over hours.
The turn
She is oriented but slower with each check, then restless and hard to rouse. Headache worsens; she vomits without nausea.
The crisis
Blood pressure 190/70 with a widened pulse pressure, heart rate 48, irregular breathing — and one pupil blows.
The save
Head of bed 30 degrees with the neck midline, hypertonic saline or mannitol, controlled ventilation, and clustering care to avoid ICP spikes.
NCLEX study section — Increased Intracranial Pressure
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Neurological
Take this chapter into practice questions on the same topic.