this mark boswell basel merch medical education coming at you live the quick little cn video short um i've not been online for a while it's been kind of busy and covered and now i got this dang here's my knee yeah toilet quadricep last week surgery tuesday anyways hey um so my last practice question was about cushing's response and those of you studying for the ce and i want you to know there is a they've done they've done a great disservice to us calling it cushing's triad cushing's reflex cushions response etc all the stuff all the literature i've reviewed it's more than just three things okay um i want to tell you this because when you're studying the cen exam i want you to know five things okay five there are three things that universally all the exam prep people and the exam question authors do talk about there's actually two others so there's actually a total of five things you need to know for the exam all are fair game because it varies between exam prep people and exam item writers first i will tell you it is not cushing's reflex cushions reflex is something totally different okay cushing's triad i want you to forget that it's more than three things because triad means three there's actually five that are fair game what we're talking about is the icp in a head injury patient as the intracranial pressure goes up causing a near-death terminal set of findings okay so for the cen exam there are five things you need to know for cushing's response they are and i'll explain each one one bradycardia why because as the icp goes up in the head it starts put pressure on the vagus nerve and that drops the heart rate that's universal another one number two is hypertension because as this dying brain as fixing a herniate it wants to perfuse itself the pressure goes up up and up okay so hypertension number two number three some respiratory changes okay there's all kinds of respiratory patterns chain stokes agnewstick apnic biots etc just know it's not the normal 12 to 20 a minute and the reason why because the respiratory control center is having too much pressure put on it they're the brain stem is it fixing herniate with the icp going up okay those are the three basics the other two that are fair game also one is a widened pulse pressure and that makes sense because as the dying brain is trying to perfuse itself the systolic goes up up and up the diastolic does not go up the same degree so therefore you have a wider pulse pressure okay and then equally amongst the other authors is pupillary changes and that could be anything okay it can be one fixed one dilated it can be one reactive one not reactive one constricted one dilated any pupillary changes so your best preparation for the ce exam is to know all five things that are possible indicators of cushing's response which means the icp is going up this patient's fixing herniates number one hypertension number two bradycardia number three respiratory changes number four a widened pulse pressure and number five there you go people already changes if you can remember all five you're gonna be best prepared for this exam and be able to answer the question anyways asked how do i know this taken the exam six times i've referenced and researched all the contemporary authors out there and i network with people who write these exam questions so cushing's a reflex and cushions triad and cushing's response five things to know hypertension bradycardia respiratory changes pupillary changes and wide pulse pressure if you know those five you'll be good to go you will not miss that question y'all take care happy thanksgiving see you soon