Brain Buckets!

August 25, 2014

Even though we’ve learned over time that Helmets are beneficial and save lives, there’s always some lug heads that think that it’s better to look cool than to protect their brain.

But how can we tell if the symptoms that our patient is displaying are the result of increased pressure in the brain and not just a low IQ? Let’s look at the Cushings Triad this medical Monday.

As pressure builds up in the brain, due to injury or medical condition, it quickly finds that expansion is bound by a hard skull. As an effect of the inability to expand outward, it starts to push the brain stem downward through the only hole in the cranium, the foramen magnum. This hole at the base of the skull is the opening that allows your spinal cord and brain stem to connect.

As we remember from our much younger days, we cannot put a square peg in a round hole, or in this case a large brain through a small opening. The body will try to compensate for this in a very predictable way.

The Cushing’s triad helps us determine if our symptoms are being caused by this pressure. Dr. Cushing found that in all cases of increased InterCranial Pressure (ICP) the body tried to compensate with these three mechanisms.

1. Hypertension with widening pulse pressure (the systolic rises faster than the diastolic)
2. Bradycardia
3. Irregular breathing

Learning to recognize these symptoms will help us better assess the needs of our patients, specifically EMS and evaluation in a hospital.

Increased ICP can occur due to medical conditions such as a stroke or edema; our most likely place will be seen through head trauma.

So let’s tighten up our brain buckets and learn how to deal with those that don’t.

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