Clinical Findings

Cushing's Reflex:Hypertension, bradycardia, unequal pupils, irregular respirations, hyperthermia.

Neuro: AMS, HA, sensitivity to light, irritability, double or blurred vision, seizures, hemiparesis, GCS <8, unequal pupils.

Resp: Abnormal respirations, tachypnea (late).

CV: HTN, Bradycardia (late), widening pulse pressure (late).

GI/GU:Nausea and vomiting.

MS: Weakness, decreased motor function, posturing.

Collaborative Management

• Monitor pupils and GCS.
• Controlled hyperventilation decreases PaCO₂, thus causing cerebral vasoconstriction and decreased ICP. Note: If capnography monitoring is available, goal should be an EtCO₂ of 30 mm Hg.
• Keep head elevated to 30°, maintain head in neutral alignment, and avoid flexion or rotation of neck.
• Closely monitor VS and neurological status.

Abnormal Extension (decerebrate posturing)

Abnormal Flexion (decorticate posturing)