شاب عمره ٣٠ سنة في العناية بعد إصابة رأس مع نزيف، وكان مستقراً. خلال ساعتين صار أكثر نعاساً، وارتفع ضغطه من ١٣٠/٨٠ إلى ١٨٨/٧٠، ونزل نبضه إلى ٤٨، وصار تنفسه غير منتظم. ماذا يدل هذا؟

A 30-year-old in ICU after a head injury with haemorrhage had been stable. Over two hours he became drowsier, BP rose from 130/80 to 188/70, HR fell to 48 and breathing became irregular. What does this indicate?

1. Cushing’s triad from severely raised intracranial pressure
2. Neurogenic shock from spinal cord injury
3. A normal pain response after the injury
4. Hypovolaemic shock from internal abdominal bleeding

Answer: A) Cushing’s triad from severely raised intracranial pressure. Rising systolic pressure with widening pulse pressure, bradycardia and irregular breathing are late signs of raised ICP and impending herniation, needing immediate action.