Which of the following sets of vital signs is MOST suggestive of increased intracranial pressure in a patient who has experienced a traumatic brain injury?

• A. BP, 92/60 mm Hg; pulse, 120 beats/min; respirations, 24 breaths/min
• B. BP, 84/42 mm Hg; pulse, 60 beats/min; respirations, 32 breaths/min
• C. BP, 176/98 mm Hg; pulse, 50 beats/min; respirations, 10 breaths/min
• D. BP, 160/72 mm Hg; pulse, 100 beats/min; respirations, 12 breaths/min

Answer: (C)

Increased intracranial pressure often triggers a Cushing reflex, a pattern that signals primary brainstem compromise. This reflex includes hypertension with a wide pulse pressure, bradycardia, and slow or irregular respirations. The set with a systolic pressure of 176 and a diastolic pressure of 98 produces a large pulse pressure, indicating hypertension in an effort to maintain cerebral perfusion. The heart rate is slow at 50 bpm, and the respirations are shallow at 10 breaths per minute. Together, these signs point to elevated ICP and possible brain herniation risk.

The other sets fit better with blood loss or shock patterns or with normal perfusion states rather than the ICP-specific reflex described above.