Cardio respiratory center– pressure on that decreases HR & RR

CPP=MAP-ICP

Cerebral perfusion pressure equals the mean arterial pressure minus the ICP

Autoregulation is lost when the CPP falls below the 50mmHg or exceeds 150mmHg

Cushing’s triad

Increasing BP

Bradycardia

Wide pulse pressure 

Respiratory slowing is also a sign

Means there is pressure on the vasomotor center in the brainstem

 VERY LATE SIGN

 VERY BAD SIGN YOU CAN’T REVERSE THE TREND

3 volumes exist within the fixed, rigid cranial vault

Brain

Blood

CSF

Under normal conditions these volumes exert a pressure that is less than 15mmHg

Severity of brain injuries is classified using the Glasgow Coma Scale (GCS)

Mild – GCS – score 13 to 15

Moderate – GCS – score 9 to 12

Severe – GCS – score < 8

Epidural hematomas

Commonly occur after a temporal linear skull fracture that lacerates the middle meningeal artery below it or from fractures of the sagittal and transverse sinuses

The hematoma develops rapidly in the space between the skull and dura and represents a life-threatening emergency

Bleeding from veins between the dura and the arachnoid spaces

May be acute, subacute or chronic

With increased use of therapeutic anticoag for cardiac, stroke and vascular problems, may be increasing the incidence of subdural hematoma from falls

Life-threatening, emergent situation that occurs when an expanding lesion (blood, edema, tumor) of the middle or temporal fossa forces the tip (uncus) of the temporal lobe toward the midline

The uncus protrudes over the edge of the tentorium cerebelli and compresses the oculomotor (third cranial) nerve and posterior cerebral artery

Uncus may be lacerated in the process and the midbrain is compressed against the tentorial edge

Pt manifests with an irregularly shaped pupil that may become fixed and dilated on the side of the herniation, a change in resp pattern, marked deterioration in LOC, and further elevation in ICP