Cushing's reflex (triad) is an ominous late sign of raised intracranial pressure representing impending brainstem herniation. The triad consists of:

• A Hypotension, tachycardia, and dilated pupils
• B Hypertension, tachycardia, and Cheyne-Stokes breathing
• C Hypertension, bradycardia, and irregular respirations ✓
• D Bradycardia, hypotension, and pinpoint pupils

Explanation

Cushing's triad indicates severely raised ICP with impending transtentorial herniation and brainstem compromise: (1) systemic hypertension (reflex response to maintain cerebral perfusion pressure), (2) bradycardia (vagal response to hypertension), and (3) irregular/slow respirations (brainstem compression). This constitutes a neurosurgical emergency requiring immediate ICP reduction.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.