{"id":3166,"date":"2026-05-27T12:52:54","date_gmt":"2026-05-27T20:52:54","guid":{"rendered":"https:\/\/www.nicolekupchikconsulting.com\/news\/?p=3166"},"modified":"2026-05-27T12:52:56","modified_gmt":"2026-05-27T20:52:56","slug":"signs-of-increased-icp","status":"publish","type":"post","link":"https:\/\/www.nicolekupchikconsulting.com\/news\/signs-of-increased-icp\/","title":{"rendered":"Signs of Increased ICP"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Being a critical care nurse, it is vital to understand how to recognize if your patient has elevated ICP.\u00a0 A good understanding of your patient\u2019s vitals and baseline assessment will be<em> essential<\/em> in monitoring your patient.<\/p>\n\n\n\n<h1 class=\"wp-block-heading\">Signs of Intracranial Hypertension<\/h1>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td>Early changes<\/td><td>Late changes<\/td><\/tr><tr><td>Headache<br>N\/V; may progress to projectile<br>Lethargy<br>Irritability<br>Slow decision making<\/td><td>Pupillary changes &#8211; <em>using a pupilometer can pick up <\/em><br>                               <em>changes earlier<\/em><br>Seizures<br>Posturing<br>Can progress to coma<br><strong>Herniation &amp; Cushing\u2019s triad = BAD<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h1 class=\"wp-block-heading\">Cushing\u2019s Triad<\/h1>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Wide pulse pressure with an increased systolic blood pressure and decreased diastolic pressure<\/strong>\n<ul class=\"wp-block-list\">\n<li>Increased sympathetic tone increases the SBP<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Bradycardia<\/strong>\n<ul class=\"wp-block-list\">\n<li>High pressure is detected by the baroreceptors in the carotid arteries and aortic arch, sending messages to the brain stem stimulating the vagus nerve to reduce the heart rate<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Irregular breathing, may progress to apnea<\/strong>\n<ul class=\"wp-block-list\">\n<li>High pressure is detected in the brain stem medulla creating an abnormal breathing pattern<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Why is Cushing\u2019s Triad bad?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><em>It is signalling brain stem compression. THIS IS VERY BAD, signalling impending brain herniation which is fatal, occurring in seconds to minutes.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Intracranial Pressure (ICP):<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Normal values:\n<ul class=\"wp-block-list\">\n<li>0\u00a0 &#8211; 15 mm Hg<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Treatment <strong>is indicated<\/strong> if sustained > 20 &#8211; 25 mm Hg<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Cerebral Perfusion Pressure (CPP)<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pressure needed to perfuse the brain<\/li>\n\n\n\n<li>MAP &#8211; ICP = CPP<\/li>\n\n\n\n<li>Goal = > 60<\/li>\n\n\n\n<li>Normal CPP: 60 &#8211; 80 mm Hg<\/li>\n\n\n\n<li>Often we target the MAP to be 70 &#8211; 100 mm Hg<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">*** The CPP is more dynamic than we thought&nbsp; and the mean arterial blood pressure decreases 10 to 15 mm Hg before getting to the brain.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Use CPPot if technology is available or transcranial doppler (TCD) although TCD is only a snapshot in time<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Stay tuned for our last stroke series blog on <strong>Management of Intracranial Hypertension<\/strong> coming soon!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">References:<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/emedicine.medscape.com\/article\/1829950-overview\">Intracranial Pressure Monitoring: Background, Indications, Contraindications<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.uptodate.com\/contents\/evaluation-and-management-of-elevated-intracranial-pressure-in-adults\">Evaluation and management of elevated intracranial pressure in adults &#8211; UpToDate<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.uptodate.com\/contents\/management-of-acute-moderate-and-severe-traumatic-brain-injury-in-adults?search=CPP&amp;source=search_result&amp;selectedTitle=1~53&amp;usage_type=default&amp;display_rank=1#H4278881320\">Management of acute moderate and severe traumatic brain injury in adults &#8211; UpToDate<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/link.springer.com\/article\/10.1186\/s13054-025-05476-7\">Monro-Kellie 4.0: moving from intracranial pressure to intracranial dynamics | Critical Care | Springer Nature Link<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Being a critical care nurse, it is vital to understand how to recognize if your patient has elevated ICP.\u00a0 A good understanding of your patient\u2019s vitals and baseline assessment will be essential in monitoring your patient. Signs of Intracranial Hypertension Early changes Late changes HeadacheN\/V; may progress to projectileLethargyIrritabilitySlow decision making Pupillary changes &#8211; using [&hellip;]<\/p>\n","protected":false},"author":11,"featured_media":3170,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[46],"tags":[],"ppma_author":[62],"class_list":["post-3166","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nurse-education"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\r\n<title>Signs of Increased ICP - Nicole Kupchik Blog<\/title>\r\n<meta name=\"description\" content=\"Learn the early and late signs of elevated intracranial pressure (ICP), the dangers of Cushing\u2019s triad, and key critical care concepts including cerebral perfusion pressure (CPP), monitoring, and brain herniation recognition.\" \/>\r\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\r\n<link rel=\"canonical\" href=\"https:\/\/www.nicolekupchikconsulting.com\/news\/signs-of-increased-icp\/\" \/>\r\n<meta property=\"og:locale\" content=\"en_US\" \/>\r\n<meta property=\"og:type\" content=\"article\" \/>\r\n<meta property=\"og:title\" content=\"Signs of Increased ICP - 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