Traditionally this is recognised in the unconscious patient by the onset of Cushing’s triad of bradycardia, hypertension and breathing difficulties.
Management using ABCDEF is appropriate with specific additional interventions:
- Open airway, use an airway (oral or N-P) and TAKE OVER breathing to hyperventilate and reduce CO2 thus CBF and ICP
- When intubating use anaesthetic drugs: laryngoscopy will cause hypertension which might precipitate coning.
- Don’t give atropine for bradycardia: increasing cardiac output in the face of hypertension can raise ICP and precipitate coning.
- Give 200ml 20% mannitol (reduces brain oedema), 20mg furosemde (switches off CSF production) and 200ml colloid (prophylaxis against diuretic induced hypovolaemia)
Consult a Neurologist or Neurosurgeon and an Intensivist: they can advise and can take over patient care.