Cushing's triad

Cushing's triad (not to be confused with the Cushing reflex) is a sign of increased intracranial pressure. It is the triad of:

1. Hypertension (progressively increasing systolic blood pressure)

2. Bradycardia

3. Widening pulse pressure (an increase in the difference between systolic and diastolic pressure over time)

Cushing's triad suggests a cerebral hemorrhage in the setting of trauma or an space occupying lesion (e.g. brain tumor) that is growing and a possible impending fatal herniation of the brain. Cushing's triad is named after an American neurosurgeon Harvey Williams Cushing (1869-1939).


Cushing triad and not cushing sign;its more common in open head injury and should be noted fast by the nurses for effective treatment.The major signs are increase systolic>160mm,widened pulse pressure,bradycardia<50 beat per minutes.

wiki so

please correct your blog post.

from wiki

Cushing's triad is a clinical triad variably defined as having:

Widening pulse pressures
Irregular breathing

or less commonly a widening pulse pressure (with elevated systolic and a either decreased or normal diastolic BP), irregular respiration, and bradycardia.[1] It is sign of increased intracranial pressure, and it occurs as a result of the Cushing reflex.

the opposite..

for it to be easily memorized
try to think of the sings of shock (hemorrhagic)
increase pulse rate (tachycardia)
narrowing pulse pressure

you're mistaken.

you're mistaken.

hypertension and widening pulse pressure


(that will lead to a widened pulse pressure)this is done by the body to provide adequate cerebral blood flow to the brain, esp. when autoregulation is not functioning.

Altered Respirations
which would probabably be kussmaul resp. due to incresead CO2

Kussmaul respirations are

Kussmaul respirations are related to DKA, cheyne stokes are related to ICP

Hypertension of 180 systolic

Hypertension of 180 systolic + HR less than 60 + Cheyne stokes respirations + unequal pupils..... is what I was taught for this.

Intracerebral Hemorrhage

The pupils do not need to be unequal. Depending on the location and extent of the bleed, the pupils can be equal but non-reactive to light.


Cushing's Triad is:
3-Irregular Respirations
Cushing's triad is a sign of increase intracranial pressure (ICP). Signs of increased ICP also include papilledema, nausea, vomiting or mental status changes.
Increased ICP also known as "intracranial hypertension" can be caused by trauma (that resulted in intracranial hemorrhage/hematoma/contusion), but it can also be caused by many other things some acute and some chronic. Some of these include: brain tumors, hydrocephalus, cerebral venous sinus thrombosis, pseudotumor cerebri, medications/toxins etc.
Cushing's triad usually results from acute increased ICP as opposed to chronic because there is no time for compensation.

Cushing's triad

This is actually a late sign of increased intracranial pressure in children twelve and older and in adults. This is rarely seen in the pediatric patient. If it is seen, death is essentially unavoidable.

will be seen in pediatric

will be seen in pediatric patients if sutures are fused

Cushing's triad

hypertension (with increased pulse pressure) bradycardia, irregular respirations.

Cushing's triad

Cushing's triad involves slowing of the respirations, not widening of the pulse pressure.

H. W. Cushing:Some experimental and clinical observations concerning states of increased intracranial tension. American Journal of the Medical Sciences, Thorofare, N.J., 1902, 124: 375-400.

Cushing's Triad

Don't mean to be putting you down, but the widening pulse pressure is kind of a hallmark sign of intracranial pressure. (October 2011.)

cushing's triad

You are exactly correct. The widening pulse pressure with reflex bradycardia is classic sign of increased ICP

Cushing's Triad

hypertension (with increased pulse pressure) bradycardia, irregular respirations.

I had always thought this as well, but I often see the irregular respirations substituted by hypertension and then widened pulse pressure on its own. I believe the comment before mine is more correct in saying hypertension (with increased pulse pressure) because with the increase in SBP you get not only hypertension but also a widened pulse pressure.

The American Academy of

The American Academy of Orthopedics Surgeons 2010 explain that "Early signs and symptoms of increased ICP include vomiting (often without nausea), headache, an altered level of consciousness and seizures. Later, more ominous signs include, hypertension (with a widening pulse pressure), bradycardia and irregular respirations (Cushings Triad)."

Cushing's Triad

Stages of increased intracranial pressure:

Stage I: Early signs of increased intracranial pressure (ICP): confusion, drowsiness, slight pupillary and breathing changes.

Stage II: Late signs of increased ICP indicate neuronal deoxygenation: widened pulse pressure (PP), bradycardia, irregular respirations (this is Cushing Triad). This is when brain hypoxia and hypercapnea begins and is associated with rapid deterioration: decreased LOC, cheyne-stokes resps, sluggish dilated pupils. Systemic arterial vasoconstriction does occur in Stage II as the body attempts to overcome increased ICP, but this is not formally part of Cushing Triad.

Stage III: autoregulation of ICP ceases to be effective. Continued increase in CO2 causes vasodilation, increased intracranial blood volume, continued increased ICP. Severe brain hypoxia and acidosis.

Stage 4: Herniation, more ischemia, small hemorrhages, obstructive hydrocephalus. When MAP=ICP cerebral blood flow ceases.

Reference: K. L. McCance, S. E. Huether, V. L. Brashers, & N. S. Rote. (2010). Pathophysiology; The biologic basis for disease in adults and children. St. Louis, MO: Mosby, Elsevier.