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A patient with a head injury has an intracranial pressure (ICP) of 18 mm Hg, the blood pressure is 144/90 mm Hg and mean arterial pressure (MAP) is 108 mm Hg. What is the cerebral perfusion pressure (CPP)?

2-mm-1-1

90 mm Hg

126mm Hg

54mm Hg

Answer and Explanation

The Correct Answer is B

Rationale:

2 mm Hg – Far too low and does not match the calculation.
90 mm Hg –Matches the calculation (MAP − ICP).

Given:

MAP = 108 mm Hg
ICP = 18 mm Hg

Calculation:
CPP = 108 − 18
CPP = 90 mm Hg

A CPP of 70–100 mm Hg is generally considered adequate to maintain cerebral perfusion in adults. Values below 60 mm Hg can result in cerebral ischemia

C. 126 mm Hg – This would be MAP + ICP, which is not correct for CPP.
D. 54 mm Hg – Likely results from an incorrect calculation.
Cerebral perfusion pressure (CPP) is calculated using the formula: CPP = MAP − ICP.

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Correct Answer is B

Explanation

Rationale:
A. This patient is on droplet precautions, which requires infection control measures, but the scenario does not indicate acute instability. While monitoring is essential, this patient is not the most critical.

B. This patient is correct because an ICP of 20 mm Hg is elevated (normal ICP is 5–15 mm Hg), and an oral temperature of 104°F indicates severe hyperthermia, which can further increase cerebral edema and risk of brain injury. This combination represents an acute neurological emergency requiring immediate assessment and intervention to prevent irreversible damage or death.

C. This patient is experiencing photophobia, a common symptom of meningitis, but it is less urgent compared with a patient with elevated ICP and hyperthermia. Symptom management is important but not immediately life-threatening.

D. This mechanically ventilated patient with a GCS of 6 is critically ill, but if the patient is already intubated and ventilated, airway and breathing are likely secured. The patient with rapidly rising ICP and high fever represents a more acute and potentially reversible threat that requires immediate assessment to prevent deterioration.

A. Intermittent mandatory ventilation B. Controlled ventilation C. Positive end-expiratory pressure D. Assist/control ventilation

Correct Answer is A

Explanation

Rationale:
A. Intermittent mandatory ventilation (IMV) is correct because IMV delivers a preset number of mandatory breaths per minute while allowing the patient to breathe spontaneously in between these breaths. The patient controls the rate and tidal volume of the spontaneous breaths, which helps maintain respiratory muscle function and promotes weaning from mechanical ventilation.

B. Controlled ventilation is incorrect because in this mode, the ventilator delivers all breaths at a preset rate and tidal volume, regardless of the patient’s own respiratory efforts. The patient cannot trigger spontaneous breaths, making it less suitable for patients who can breathe partially on their own.

C. Positive end-expiratory pressure (PEEP) is incorrect because PEEP is not a mode of ventilation; it is a ventilator setting that maintains positive pressure in the lungs at the end of exhalation. PEEP helps improve oxygenation but does not determine the mode or rate of breaths.

D. Assist/control ventilation (A/C) is incorrect because in A/C mode, the ventilator delivers a preset tidal volume with every patient-initiated breath, and also provides mandatory breaths at a set rate if the patient does not initiate them. While it allows some patient-initiated breaths, the tidal volume is controlled by the ventilator, not the patient’s spontaneous effort as in IMV.

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A patient with a head injury has an intracranial pressure (ICP) of 18 mm Hg, the blood pressure is 144/90 mm Hg and mean arterial pressure (MAP) is 108 mm Hg. What is the cerebral perfusion pressure (CPP)?

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