2d • Paramedic Talk
ICP & Brain Herniation
Two classic signs of increased ICP:
- Hypertension
- Bradycardia (Cushing’s reflex)
Expected signs of brain herniation:
- Unequal pupils
- Posturing
- Irregular respirations (Cheyne stokes or Biots/Ataxic)
- Rapid decline in mental status
Treatment for ICP (prehospital):
- Hyperventilation ONLY if signs of herniation (get EtCO2 to 35-40)
- Mannitol is NOT used in EMS unless critical care - 1g/kg over 10min for edema, not blood.
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ICP & Brain Herniation
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