NREMT Paramedic Cognitive ExamTraumaMedium
A 22-year-old male is involved in a high-speed motor vehicle collision. On assessment, he is unconscious, has unequal pupils (left pupil dilated and sluggishly reactive), and his right arm and leg are exhibiting decorticate posturing. His blood pressure is 180/90 mmHg, heart rate is 60 bpm, and respiratory rate is 10 breaths/min. These findings are MOST indicative of which of the following conditions?
- AIncreased intracranial pressure (ICP).
- BStatus epilepticus.
- CSpinal cord injury at the cervical level.
- DHypovolemic shock.
Show answer & explanationAnswer & explanation
Correct answer: A. Increased intracranial pressure (ICP).
The constellation of signs including altered mental status (unconscious), unequal pupils, decorticate posturing, hypertension, bradycardia, and bradypnea (Cushing's triad) are classic indicators of increased intracranial pressure, often due to a severe traumatic brain injury.
Why the other options are wrong
- B. Status epilepticus involves prolonged seizures; while altered mental status is present, unequal pupils, posturing, and Cushing's triad are not primary signs.
- C. Cervical spinal cord injury might cause hypotension and bradycardia (neurogenic shock), but not typically unequal pupils or decorticate posturing.
- D. Hypovolemic shock typically presents with hypotension and tachycardia, not hypertension and bradycardia.
Signs of Increased ICP
Clinical manifestations resulting from elevated pressure within the skull, often due to brain injury, hemorrhage, or edema.
- Altered mental status is an early sign.
- Pupillary changes (anisocoria, sluggish reaction) are common.
- Cushing's triad (hypertension, bradycardia, irregular respirations) is a late and ominous sign.
Memory trick: Pressure in the brain makes a patient look CRAZY!