NREMT Paramedic Practice

Which of the following indicates an increased ICP involving the middle brainstem?

1. Widened pulse pressure

2. Pupils that are reactive

3. Ataxic respirations

4. Hyperthermia

The correct answer is: Widened pulse pressure

An increased intracranial pressure (ICP) involving the middle brainstem can lead to various physiological changes, one of which is a widened pulse pressure. This phenomenon occurs due to the effects of increased pressure on the brainstem, which can disrupt the normal regulation of the autonomic nervous system. Widened pulse pressure is characterized by an increased difference between systolic and diastolic blood pressure. It often signifies that the body is attempting to compensate for increased ICP by increasing cardiac output or altering blood flow dynamics in the central nervous system. In essence, as the brain becomes increasingly pressured, the cardiovascular system may respond with changes in blood pressure that result in this widening. In contrast, the other signals do not correlate specifically with increased ICP stemming from the middle brainstem. Reactive pupils suggest that the brainstem functions, particularly in the pathways that control pupil reflexes, remain intact. Ataxic respirations indicate a level of brainstem dysfunction rather than increased ICP specifically. Hyperthermia may occur in various conditions but is not directly indicative of increased ICP involving the middle brainstem.