Which of these vital signs, taken 1 hour after admission, will be of most concern to the nurse in a patient with head injury?

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

Answer: (C)

Rising intracranial pressure after head injury often presents with Cushing's triad: hypertension with a wide pulse pressure, bradycardia, and irregular or slowed respirations. The vital signs shown—systolic 156 with diastolic 60 (wide pulse pressure), pulse 60 (bradycardia), and respirations 14 (reduced)—fit this pattern. This combination means the brain is under significant pressure and the brainstem is being affected, signaling a neuroemergency and risk of herniation. The body’s attempt to preserve cerebral perfusion pressure by increasing systolic pressure is evident, but the accompanying slow heart rate and slowed breathing indicate critical ICP elevation. This set of signs is more concerning than others that show tachycardia or more stable breathing patterns, which do not reflect the same degree of intracranial compromise. Immediate assessment and measures to reduce ICP are required.