If intracranial pressure is rising, which of the following trends in vital signs would you expect?

• A. Increasing temperature, increasing pulse, increasing respirations, decreasing blood pressure
• B. Increasing temperature, decreasing pulse, decreasing respirations, increasing blood pressure
• C. Decreasing temperature, decreasing pulse, increasing respirations, decreasing blood pressure
• D. Decreasing temperature, increasing pulse, decreasing respirations, increasing blood pressure

Answer: (B)

Rising intracranial pressure triggers a compensatory response to preserve cerebral perfusion called the Cushing reflex. The body raises systolic blood pressure to push blood through the brain, while the heart rate slows (bradycardia) and breathing becomes irregular or slows. Temperature changes aren’t a defining part of this pattern, but fever can occur for other reasons.

So the most accurate trend among vital signs is increasing blood pressure with decreasing pulse and decreased or irregular respirations. The other patterns either show the wrong direction for the heart rate, or for the breathing, or both, which don’t fit the typical Cushing response.