Intracranial Hemorrhage 脑出血演稿知识讲解.pptVIP

BP Management Avoid hypotension If systolic BP drops to less than 90 mmHg, consider judicious fluid boluses and/or start pressors BP Management Labetalol 20 mg IV, followed by 40 80 mg IV q10 min Titrate to BP or max 300 mgs admin Nipride 0.5-1.0 mics/kg/min Theoretically can increase cerebral blood flow and thereby intracranial pressure BP Management Treatment should be started within 6 hours of symptom onset A Prospective Multicenter Study to Evaluate the Feasibility and Safety of Aggressive Antihypertensive Treatment in Patients with Acute Intracerebral Hemorrhage Journal of Intensive Care Medicine, Vol 20, No 1 Burke, Dorfman-not yet published Fever Management Elevated temperatures can increase the degree of ischemic injury. Etiologies include infection, neuronal injury, SIRS Studies have demonstrated increased morbidity and mortality in patients with sustained temperature elevation. Treat temperture 38.5? C Acetaminophen or a cooling blanket best options. Seizure Therapy Neuronal injury may lead to seizures Nonconvulsive seizures may contribute to coma in up to 10% of neurocritical patients Consider prophylactic antiepileptic therapy in setting of ICH Lobar hemorrhage-35% seizure rate Fosphenytoin or phenytoin Medical Therapy Euvolemia Isotonic crystalloid solutions Electrolyte abnormalities Correct deficits Acid/base disorders Correct them if present Steroids-no benefit Blood Clot ICH Hemorrhage Growth Until recently, bleeding in patients with ICH was thought to be completed within minutes of onset Several small studies describe a few patients who had an increase in the volume of parenchymal hemorrhage on repeated CT scans ICH Hemorrhage Volume Old concept-Hemorrhage static process; bleeding complete in a minutes New concept-Hemorrhage is dynamic; process continues for several hours Marc Dorfman, MD, FACEP, MACP Intracranial Hemorrhage Marc Dorfman, MD, FACEP, MACPEM Residency Program Director Resurrection Medical CenterChicago, IL Marc Dorfman,