Cushing Reflex - Cushing Triad - Intracranial Hypertension - Emergency Medicine and EMS/ EMT

[@MedicosisPerfectionalis]

💊 👨‍🏫 Antibiotics Lectures: www.medicosisperfectionalis.com/products/courses/antibiotics/

[@dereknicolas7635]

"Medicine does make sense when explained properly" Seriously man, out of all the textbooks, websites, and professor explanations none of them could explain it well enough that it made sense and yet, you managed to explain it so well, thank you. Earned yourself a new follower for sure!

[@MedicosisPerfectionalis]

I appreciate you so much!

[@gabriellesavoie8395]

CPP Normal Range : 70-100 mmHg, ICP Normal Range: 5-15 mmHg, B-Brandypnea, and A- CT scan of the head. CPP = Mean Arterial Pressure (MAP) - Intracranial Pressure (ICP). MAP = (Diastolic BP x 2) + Systolic BP / 3. Thank you.

[@WizKidNas]

Nursing student here! Why CT over Xray? (probably a dumb question)

[@MedicosisPerfectionalis]

CT over x-ray for which condition?

[@WizKidNas]

@@MedicosisPerfectionalis In your case study example at the end (last two questions).

[@chasealfman]

@@WizKidNas In general, X-rays shows bones well, but aren’t very good at finding soft tissue problems. Specifically, for this patient: elevated BP + bradycardia in a patient with a positional headache...Medicosis is telling us that there is Cushing Signs in the setting of what could be a brain bleed (or something sloshing around in his head). That’s bad. And likely a brain problem, not a skull problem. CT better for soft tissue (and actually fantastic at picking up acute bleeds)

[@grayhero1]

CPP

[@Boong525]

medicine = everything makes sense once explained correctly. oh goodness this is so true

[@MedicosisPerfectionalis]

The best comment ever...You made my day!

[@MedicosisPerfectionalis]

Hahaha 😁 ...Thanks!

[@ivanlim3689]

“Start to cry and weep, just for a second because we don’t have time” 😅😅😅😂😂😂😂😅😂😅😂

[@MedicosisPerfectionalis]

Haha 😂

[@pixzelmedia]

😂 😂 😂 😂

[@healer6697]

😂😂😂😂

[@katech9836]

😂😂😂😂

[@xo_ashleynicole255]

This made me laugh 🤣

[@xBassel92x]

Have been going through your work for the last couple of days. It's amazing how detailed your lectures are, and how deep you go in elucidating subjects. I just want to tell you my sheer appreciation for the amazing job you do despite it probably not paying you back enough. I hope you will continue doing this!

[@MedicosisPerfectionalis]

Sure! Thank you so much...What a great comment 😊

[@DioneFigueiredo]

It's incredible when you understand something you thought was very difficult, almost impossible. Thanks for the lecture! From Brazil here! :)

[@MedicosisPerfectionalis]

Wow 🤩 That’s awesome 👏 Thank you so much for watching! Can you please help me by sharing?

[@williamforzani709]

As an EMT student, I didn't understand why bradycardia happened even with the extreme hypertension, this helped a ton. Thank you!

[@MedicosisPerfectionalis]

Glad it helped! Thank you so much watching!

[@itsmypinkypromise4489]

One of the best explanation i have ever heard. Straight to the point. Easy to understand. All the best. New subscriber here.

[@MedicosisPerfectionalis]

Thank you so much 😊 Welcome 🙏

[@johnjohnsonaddai-asante6353]

How can I forget what he just taught with his great sense of humor. lol. Thanks a lot!

[@MedicosisPerfectionalis]

My pleasure 😇

[@baselsalama4187]

انا هكتب بالمصري معلش علي النعمة بنعمة ربي انت عظيم انا بتابعك من مصر وعايز اقولك "عظمة علي عظمة يا ست " زي ما الجدع قالها لام كلثوم

[@dr.elaineluther6562]

Q1: normal cerebral perfusion pressure is 60-80 mm Hg Q2: normal intracranial pressure is 5-10 mm HG Q3. none of these are expected in the physical exam findings Q4: This patient needs STAT CT scan of head

[@zoek2136]

Thank you Dr. Elaine

[@مسكالختاممحمد]

You are the one who make medicine makes sense ❤️❤️

[@MedicosisPerfectionalis]

Thank you 😊

[@rumsha_khalid]

Just came across this video while studying for Step 1. Simple, effective, fun explanation. Teachers like you make studying pleasant. Needless to say you have gained me as a subscriber. Thank you. P. S. I love your voice and accent.

[@MedicosisPerfectionalis]

I am honored!

[@nicolasjoyavila1238]

"good things happen to those who wait". - medicosis perfectionalis 2018

[@MedicosisPerfectionalis]

Haha 😂

[@michaelthompson3483]

at 4:28, he says CN6 palsy, but this is supposed to be CN3 palsy (oculomotor n.) due to compression against the clivus bone at the base of the skull; this results in ipsilateral dilated and nonreactive pupil and later the "down and out position" of the eye (parasympathetic fibers surround the motor fibers in the nerve and thus are affected first).

[@MedicosisPerfectionalis]

Then why do we commonly see CN VI palsy in cases of idiopathic intracranial hypertension?

[@michaelthompson3483]

@@MedicosisPerfectionalis I wouldn't say "commonly" as it is a rarer symptom of IIH. CN 6 is most commonly affected in IIH, but IIH in and of itself is a rare disease that usually affects young overweight females, and it is usually chronic or subacute, not an acute emergency as your video says. Thus, you don't really see the Cushing reflex in IIH. There are other more common causes of emergent intracranial hypertension that affect a larger number of people and include a wider variety of patients. In these cases, brain herniation is the biggest threat, and the most commonly seen cranial nerve involvement is CN3 for the reasons I stated before.

[@passionate_medico]

Love the way you are passionate about teaching and enjoying medicine....! Great

[@MedicosisPerfectionalis]

Thank you 🙏

[@laurens2386]

As a medical student from Belguim, I gotta say thanks xD

[@MedicosisPerfectionalis]

My pleasure!

[@dristydristy1351]

Amazing lecture. thanks for putting your valuable time and effort to help others. All the best wishes for every aspect of your life. Love from Bangladesh.

[@princess_katana]

Wow I just discovered this channel while studying for my exams and looking for a better explanation. Everything makes so much sense, 1000x better than all my lectures!! Also the crying joke 😂😂😂👌 New subscriber here 🙌

[@MedicosisPerfectionalis]

Thank you!

[@elizabethrodriguez9133]

Thank you!! Laughed when you said to cry a little LOL

[@MedicosisPerfectionalis]

Thank you ☺️

[@mecca8260]

I just discovered your channel, your explanation is just PERFECT thank you 👌🏻❤️

[@MedicosisPerfectionalis]

My pleasure 😇

[@eddy1978]

Can't fast forward or skip this video Everything explained so perfectly and your sense of humour ofcourse is amazing 😂😂 Time well spent watching this video ❤❤❤

[@Lycheemolala_nrn]

Good video,,now I understood why HR is reduced…Bravo!👏

[@popolynn2]

"please calm down and wait"

[@MedicosisPerfectionalis]

😃😃

[@nanoukituandamakombele5943]

I really like it as well,,,his sense of joke a good one to keep the learners more focus ,,,please calm down and wait ,,,, if you fail after this explanation blame yourself ..lol

[@wendellramos4937]

Which anti-hypertensive drug is the most appropriate and which to avoid for this type of condition?

[@aasemahsan]

3:47 Mechanism of Cushing Reflex ❤️

[@Tinyteacher1111]

Awesome video, and you have a good sense of humor. My 36 year-old son has been diagnosed with first mold toxicity, but his lowered immune system let a diagnosis of Lyme, Babesia, and anaplasmosis. Then, he got Covid after Christmas in Jan. 2022, and his head pressure went through the roof. He’s still in horrible pain, and it’s 8 months later. He’s seeing 4 different types of specialist doctors, and is being treated for these infections, but no one can figure out what, exactly is causing this excruciating pain. He sleeps with ice packs, has lost a lot weight, and barely gets up. He does have forward head posture, and I’m not sure if that’s keeping the pressure in his brain, but he complains all day long when he doesn’t sleep. He also has horrible nightmares, hallucinations (cut back his meds), delusions, paranoia, depression, anxiety, and I’m going nuts, as his mother! He’s had meningitis at age 7, several severe TBIs, and now this. I was told it was either the mold or the Babesia, but I also think, by his neck placement, it could be cervical instability. He won’t go back to the upper cervical chiropractor I was taking him to, although his neck felt better, but maybe I should try it again. He’s going for neurofeedback and hypnosis, but I’m not sure these will work if there’s a physical problem. Can ANYONE tell me what this could be? He’s ready to jump off a bridge and can’t stay by himself for more than an hour. He’s scared to death! I am too!

[@SteveSaxony]

dont go to a chiropractor, im a doctor and they cause serious damage, sometimes fatal. chiropractors are not doctors but pretend to be.

[@tarsun]

i'm studying for my post grad after doing mbbs. this was helpful. thank you.

[@MedicosisPerfectionalis]

My pleasure 😇 Good luck with your career 👍

[@tbip2001]

This is fantastic. Could you talk a little about the timeline of this process? For example I’m guessing stomach ulcers take time to form so can a person have Cushing signs but still be alert and orientated? For example , the question at the end has a person experiencing a Cushing a triad but a gcs 15 and has been suffering this for 3 weeks . I’m a uk paramedic and we tend to associate these symptoms only with acute onset and greatly reduced gcs patients. Thank you

[@diongibbs312]

I have Brachycardia of 49 BPM and pre-hypertension and history of traumatic brain injury with suspected CTE

[@tharindubatuwita678]

Good explanation But no need to cry when you see cushing reflex...try to give mannitol Intubate paralyse and ventilate and transfer to a nerosurgicalcenter as soon as possible....

[@samarseneault2182]

Very well explained! Learned this in physiopathology class last week

[@MedicosisPerfectionalis]

Cool! Keep slaying it!

[@benbenny4256]

you mean pathophysiology.....

[@babaali7660]

Pressure on respiratory centrum - > irregular breathing, but how exactly does it work? What is the mechanism?

[@honeyorbunny]

The only video on youtube which ist explaining why and how heartfrequence, Vasoconstriction occures and you even mention those important receptores! great work ym friend. Btw: are you studying medicine?

[@MedicosisPerfectionalis]

Yup! I am a medical student...and I can’t thank you enough for your great words and encouragement...You made my day! Good luck with everything 🍀

[@nanoukituandamakombele5943]

you are the best...true medicine becomes easy when it s well explained ,,thx a lot ,,BRAVO

[@MedicosisPerfectionalis]

Thank you so much 😊

[@ranabakri8535]

Incredible work as always , thank you from the deep cerebral arteries medicosis!

[@MedicosisPerfectionalis]

You’re always welcome!

[@am_zzzo]

Thanks for this video! This was entertaining and I understood it very well! I laughed at “start to cry and weep for seconds” so much 🤣

[@MedicosisPerfectionalis]

Haha 😂

[@elizabethalexander3304]

Thank you ! You explained it so beautifully

[@MedicosisPerfectionalis]

You’re very welcome ☺️

[@arthi8439]

Case of the day answers 1)b because there will be irregular breathing as well 2)a to rule out the cause of increased icp

[@K_B18532]

1 billion thanks 🙏🙏 the best explanation ever, thank you for all your effort 🙏🙏🙏

[@MedicosisPerfectionalis]

My pleasure 😇

[@reddybhavish2872]

ICP normal range 4 to 15 mm/HG Cerebral perfusion pressure= MAP -ICP 85MM/HG =100-15

[@paolagil883]

New grad in the ICU here! Great video much needed! :)))

[@MedicosisPerfectionalis]

Thank you so much 😊

[@Beshak123]

Excellent and concise explanation. Thank you so much!

[@lorrainebo1]

Tip: Increase the playback speed to 1.25. You're welcome :)

[@MedicosisPerfectionalis]

👍👍

[@adhamalaaeldin8550]

make that 1.5

[@AnjorinOmotola]

Nope, 1.5😅

[@user5074]

I suggest that you put the link to the answer of the questions in the description box, because I can't search for a Facebook post from 2018 in 2021 lol Thank you for the video, it is so helpfull

[@emschlem4908]

What do u mean" HTN will press on your respiratory center"? The pressure is exerted on the blood vessels from the inside. Or do blood vessels just next tho the resp center expand due to HTN and craete mass effect?

[@uriahfingerhut1408]

Dude, you are natural

[@MedicosisPerfectionalis]

😃 Thanks

[@jorgeguerra3841]

What causes the systolic and diastolic be widened? Why the widened pulse pressure?

[@yessicahernandez3403]

normal ICP 0-15 mmHg Normal CPP 60-100 mmHg

[@MedicosisPerfectionalis]

Excellent...You got it 👍

[@jkyoung7801]

Medicosis Perfectionalis i thought icp is more like 5-15 because your brain is usually under some form of pressure rather than 0 or no pressure

[@dhineshkr2844]

That "good things happen to those who wait" is nice😂👍

[@MedicosisPerfectionalis]

:)

[@fallenangel8785]

المصري معروف بقوته وبجبروته 😂 والله يا دكتوربنحبك ❤

[@MedicosisPerfectionalis]

Thank you, Sir!

[@mariasabir8085]

Its my favvv channel

[@MedicosisPerfectionalis]

Thank you 🙏

[@pranitamatani]

Really good videos, sir! You explain everything so well, and in not very lengthy videos to leave one bored...love the jokes in between! :)

[@MedicosisPerfectionalis]

Excellent! Thanks for letting me know! 😊

[@moukhshiii7220]

Why does this only happen in this occasion and say not any situation that elevates blood pressure??

[@merihseriz821]

I have a neurosurgery exam 3 days later and I am so happy that I found this man

[@MedicosisPerfectionalis]

Thank you 🙏 Good luck 🍀

[@merihseriz821]

@@MedicosisPerfectionalis I passed it! Thank you

[@MedicosisPerfectionalis]

Awesome 👏 Congratulations 🎉🎈🎊

[@epstein1881]

CPP: 50-70 mmHg ICP: 5-15 mmHg

[@suliemansy2715]

only you make medicine easy ,many thanks

[@boukaisaya5478]

Stage 2 : there is a stimulation of parasympathetic ➡️: bradycardia so why there is no vasodilation (because of parasympathetic) so there is mo more ⬆️HTN

[@AnnaTyson-w5w]

Can Anyone explain how the widening pulse pressure makes sense with bradycardia and HTN? Is it because the vessels are so squeezed that it depletes the vessels of fluid during diastole? I'm just a little confused.

[@ainasakinah2828]

CPP - 80 to 100 mmHg ICP - 5 to 10 mmHg

[@tharanibowala6766]

1 60-80 2 5-15 3b 4 1

[@PainintheHead-ib4ox]

Wow! I remember describing periods of not breathing when lying in bed at night to my physicians on my diagnosis. Nothing more was mentioned about it. Thanks for the information!

[@MedicosisPerfectionalis]

You’re welcome! Please talk to your doctor.

[@khalidakafzi5341]

Normal value of CCP = 60-80mmhg Normal value of ICP= 7-15mmhg - we will expect a bradypnea ( to complete the triade of Cushing reflex then going to cry where nobody can see u :) ) ..next step is CT scan? Btw. They said to us to propose a MRI because it's better for showing the cerebral lesions..

[@zmzmcardp]

ICP= 7-15mmhg CPP= 60-80 mmhg

[@diannahichez7349]

Normal ICP 5-15mmHg Normal CPP 60-100mmHg

[@zeelpatel8049]

thank you so much. Last two 1-b 2-a

[@pixzelmedia]

Very well explained Med. You the best!

[@MedicosisPerfectionalis]

Thank you 🙏

[@nurshahfikahhidayah6752]

What a great yet simple presentation that you gave in discussing about this cns ischemic response .....plus adding a joke *which i laughed at it a little* kinda a good way of making this more interesting ... Hope to see more vids from you, sir ♥♥♥♥ loves from medical student, Malaysia

[@MedicosisPerfectionalis]

Same love and respect to the great people of Malaysia...Thank you so much :)

[@J0sho495]

I like your sense of humour. Very well explained. Thanks.

[@MedicosisPerfectionalis]

HaHa! Thank you 😊

[@parmarravikumar7864]

CPP 50mmHg ICP 60-15mmHg

[@Anton-xd1ks]

But how can the patient maintain a high BP when brady occours? - emt student

[@sophiah8794]

When I wake I get bp 148/81 pulse 45. Is this cushing reflex? Sometimes higher bp. I have bradycardia.

[@AqsaSadiq-x6x]

Your videos are life saving ❤

[@amaranthines.]

Thank you! The volume is low on this one.

[@baozi9792]

Cpp= map (50 to 150 mmhg) - icp (5 to 15 mmhg)

[@pezhvakM6]

Cerebral blood flow(CBF)=Cerebral perfusion pressure (CPP)/cerebral vasculature resistance(CVR) CPP=Mean arterial pressure - ICP Great video,Thanks 👍🏻

[@ifyifeoma6150]

You’re always a life saver. Do you have a video on the treatment?

[@MedicosisPerfectionalis]

Thank you…I’ve talked about the treatment of intracranial hypertension in my Emergency Medicine Course: www.medicosisperfectionalis.com/

[@NLKEquestrian]

This saved my life

[@MedicosisPerfectionalis]

Awesome 👏 I am honored!

[@vitalfirstaid]

I love the way this is presented -

[@MedicosisPerfectionalis]

Thank you 🙏

[@naderfayek7285]

Really amazing thank you so much

[@talaiscomingafteru]

يا الله شو بحبك

[@MedicosisPerfectionalis]

:)

[@azmagaref]

I was diagnosed with hypertension in November 2022, Dr started me on an ACE Perindopril 7.5mg daily, since then I've been having this feeling like there's a rock lodged in my head, it feels heavy and I feel unstable. But recently in the past few days my head feels like it's chocked, coupled with dizziness and radiating aches behind the eyes and the back connection to the neck. Is this a sign of intracranial hypertension? It comes in waves and gets worse when I start to move around and while driving, I do suffer from anxiety disorders and on medication for that. I just don't know if this is caused by anxiety or have high blood pressure spikes caused this condition you are analysing !! Should I go to hospital and ask for an MRI?

[@eduardat3449]

You are amazing, best teacher ever! Thank you so much, you are helping me a lottttttttttt!! from Brazil :D

[@prajwalkadam9018]

Why is parasympathetic activation only causing decrease in Heart rate and not Hypertension? Coz baroreceptor activation should also cause hypotension?

[@agamemnon7461]

Not sure how in an emergency that can lead to death, a stomach ulcer will develop? An ulcer needs months to years to develop. Do we have that time in this particular case?

[@MedicosisPerfectionalis]

Not necessarily…Also it doesn’t have to be an ulcer, it could be an erosion. You don’t want to step on the vagus’s nerve 😉…Moreover, there’s a similar condition called “Curling ulcer” which also takes place acutely! Hope this helps!

[@medstudyplaylist9295]

I love your videos, but I would prefer the solutions to your questions here on youtube. couldn't find on FB

[@محمدعماد-غ3ظ6ظ]

شكرا

[@angelinagondek1327]

1. CPP normal range 70-100 2. ICP 0-10mmHg or 15mmHg High side of normal

[@MedicosisPerfectionalis]

Welcome to Medicosis 👋

[@ahmedsherif100]

Great but why parasympathetic in number 2 doesn't decrease blood pressure too ?

[@MedicosisPerfectionalis]

Parasympathetic doesn’t supply arterioles. Moreover, many books say that it doesn’t supply the ventricles to the same extent the sympathetic does.

[@ahmedsherif100]

@@MedicosisPerfectionalis thank you so much ❤

[@rawantaher191]

thank you

[@nohaazzoz4404]

Please Doctor, the ulcer resulting in stage 2, Is it called Cushing Ulcer or Gushing Ulcer??

[@MedicosisPerfectionalis]

Stage 2 of what?

[@medlife123]

Can anyone answer me a question " It is given in guyton and hall international edition 13 page 223 'when the cerebrospinal fluid pressure rises to equal the arterial pressure, it compresses the whole brain, as well as the arteries in the brain, and cuts off the blood supply to the brain' here if cerebrospinal fluid becomes equal to the arterial pressure how can it compress the arteries

[@MedicosisPerfectionalis]

Arteries (carotids and vertebrals) have to push blood upwards against gravity. This is not going to happen unless the pressure at the destination (brain) is lower than the pressure in these arteries. In cases of rising CSF pressure that exceeds arterial pressure, the blood is not going to be pushed upwards and the arteries of the brain will be empty, and therefore something else (CSF) has to take their place. It’s fluid mechanics and the Monroe-Kelly hypothesis!

[@tanzeelmurtazaa]

1) 60_80mmHg 2)15mmHg 3)Bradypnea 4)CT scan brain

[@Tinyteacher1111]

What do these things mean? I’m a mom with a son who has had horrible intracranial head pressure for 8 months! I’m desperately trying to find out why my son is suffering so badly. He has Lyme and Babesia.

[@javeriahayat212]

Aah you've made this so easy!

[@brahmamg1885]

Will MABP not rise above ICP due to increase in peripheral resistance (when the arteriole is getting compressed due to ICP)

[@tunesofus9127]

Thank you sir Easy to understand and straight to the point

[@MedicosisPerfectionalis]

My pleasure 😇

[@D0CTR1NEE]

@Medicosis your work is amazing your videos helped me with almost every difficult topic i had trouble understanding . Can you make a video on how to quickly diagnose different types of luekemias as well ? lookin forward to your answer

[@MedicosisPerfectionalis]

Thank you so much 😊 That’s a good idea 💡

[@Tascine2141]

Hi,HOW would furosemide be used to treat ICP?

[@MedicosisPerfectionalis]

What do you mean? Are you asking about the mechanism or the route of administration?

[@mahveenahussain1269]

Can you explain how the parasympathetic ns starts working while the sympathetic ns is giving a fight or fight response? Doesn't one supresses the other??