Increased Intracranial Pressure

Raised intracranial pressure (ICP) is not simply a high monitor reading. It is a threat to cerebral perfusion and can progress to brain herniation. In severe adult traumatic brain injury (TBI), sustained ICP above 22 mm Hg is treated; however, acute herniation can occur independently of a sustained threshold and demands immediate action. The practical sequence is: recognize a change from baseline, protect oxygenation and perfusion, call for urgent help, support ordered ICP-lowering measures, and reassess after each intervention. A patient who becomes increasingly drowsy, vomits repeatedly, develops a new pupil asymmetry, or shows abnormal posturing has a neurological emergency even if the last scheduled assessment and last ICP value were reassuring.