During head injury assessment, which change in pulse is most concerning for a significant head injury?

• A. rapid
• B. bounding
• C. slow
• D. strong

Answer: (C)

Monitoring pulse quality during head injury helps you spot changes in intracranial pressure and brainstem function. A slowing pulse, or bradycardia, is the most concerning because it often signals rising intracranial pressure with potential brainstem involvement. This pattern, part of the Cushing reflex, can occur when the brain is under pressure, leading to high blood pressure and a slower heart rate as the body tries to maintain cerebral perfusion. That combination points to a dangerous situation, such as impending herniation, and requires urgent assessment and management. Faster, bounding, or unusually strong pulses are less specific to intracranial injury and more likely related to pain, anxiety, fever, hypoxia, or circulatory issues not directly indicating brain injury.