ICP Escalation Timeline: From First Drowsiness to the Cushing Triad
The skull is a fixed box, so compensation buys time and then runs out all at once — stable, stable, stable, then suddenly not. Place the five findings in the order they actually appear and watch where the Cushing triad lands: it is a late sign, not a warning. Then sort each intervention into the mechanism that makes it work, because everything on this care plan does one of only three things.
Mr Ellis, 58, day 1 after a large left MCA infarctHe was conversational at 0700. Over the next hours these five pictures appear. Tap them in the order they appear, earliest first. The bench only accepts the next correct finding — and it will tell you why the one you reached for comes later.
Tap the finding that appears next
Sort every order on the ICP care planEach intervention below either improves venous outflow from the head, removes volume from the vault, lowers metabolic demand — or is harmful and does not belong here at all. Pick a bucket for each one.
Item 1 of 14
Monro–Kellie: compensation, then the cliff
Why the curve bendsThe vault holds brain at about 80 percent, blood at about 10 percent and cerebrospinal fluid at about 10 percent. The brain compensates first by displacing cerebrospinal fluid into the spinal subarachnoid space and increasing its absorption, then by shunting venous blood out of the cranium. Early on, a large added volume raises pressure very little — which is exactly why a patient looks deceptively well while a haematoma grows. Once compensation is exhausted, a coughing spell, a poorly timed suction pass or a few more millilitres of clot produces a steep, sometimes catastrophic rise.