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What Is Cushings Triad?

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Cushing's triad is the term used to refer to three signs that can appear in people who are suffering from life-threatening intracranial pressure (ICP). The triad is said to be present when the head-injured patient is hypertensive (has high blood pressure), has a slow heart rate for his or her age group (bradycardia), and is breathing irregularly.

In many medical emergencies there are what are known as early signs and late signs. Generally, the injured patient has a better chance of survival if much needed interventions are performed during the presentation of early signs. Late signs, however, are much more ominous and often signify that the patient's chances of survival are greatly reduced. The presentation of Cushing's triad alerts health care providers that the brain is suffering what might be permanent damage that could lead to neurologic deficit or death.

Among the irregular patterns that might be seen in a patient suffering ICP and presenting Cushing's triad include: Cheyne-Stokes respirations, central neurogenic hyperventilation, and Biot,also known as ataxic respirations. Hypertension is considered to be present when the systolic blood pressure is above 140mm Hg or when the diastolic blood pressure is higher than 90mm Hg. An adult should breath at a rate of between 12 and 20 respirations per minute. And, the pattern should not be one of those we have previously mentioned.

Cheyne-Stokes Respirations


Although there are three different alarming breathing patterns that can be seen in Cushing's Triad, the level of intracranial pressure can determine which one presents. For example, Cheyne-Stokes respirations which are characterized by fast breathing, followed by slow breathing, separated by apneic (non-breathing) periods, can present during mild elevation of ICP.

Central Neurogenic Hyperventilation


If the level of ICP worsens to the moderate level, central neurogenic hyperventilation might present. This irregular pattern is one in which the patient has deep and rapid respirations.

Ataxic (Biot) Respirations


If ICP becomes severe, ataxic respirations, also known as Biot respirartions might be observed in the presentation of Cushing's Triad. In Biot respirations, everything is irregular. The patient's rate, pattern, and volume of breathing are noticeably irregular.

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