NREMT Emergency Medical Technician (EMT) Cognitive ExamTraumaHard
A 50-year-old male was struck in the head with a baseball bat. He is conscious but confused, with a Glasgow Coma Scale (GCS) score of 12. His vital signs are BP 160/90 mmHg, HR 50 bpm, RR 8 breaths/min. These vital signs are MOST indicative of which condition?
- ASpinal shock
- BHypovolemic shock
- CNeurogenic shock
- DCushing's triad
Show answer & explanationAnswer & explanation
Correct answer: D. Cushing's triad
The patient's vital signs (hypertension, bradycardia, irregular/slow respirations) are the classic presentation of Cushing's triad, which indicates increased intracranial pressure (ICP) and is a critical finding in severe head trauma.
Why the other options are wrong
- A. Spinal shock is temporary loss of motor, sensory, reflex, and autonomic function below the level of a spinal cord injury, often presenting with hypotension and bradycardia but differing from classic ICP signs.
- B. Hypovolemic shock typically presents with hypotension and tachycardia, opposite of this patient's presentation.
- C. Neurogenic shock involves hypotension and bradycardia, but often with warm, dry skin, and is usually due to spinal injury, not directly increased ICP.
Cushing's Triad
A set of three clinical signs that indicate increased intracranial pressure (ICP): hypertension (widening pulse pressure), bradycardia, and irregular respirations.
- Indicates severe brain compression.
- A late and ominous sign of increased ICP.
- Requires immediate intervention to prevent herniation.
Memory trick: Cushing's: Pressure Up, Heart Down, Breath Slow!