Template:ICH Treatment: Difference between revisions
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*30 degree elevation will help decrease ICP<ref>http://stroke.ahajournals.org/content/38/6/2001.full</ref> | *30 degree elevation will help decrease ICP<ref>http://stroke.ahajournals.org/content/38/6/2001.full</ref> | ||
===Blood Pressure=== | ===Blood Pressure=== | ||
*Few studies on optimal management however many [[Intracranial hemorrhage (main)|guidelines recommending moderate reduction ]], often a goal systolic of 140-160's | *Few studies on optimal management however many [[Intracranial hemorrhage (main)|guidelines recommending moderate reduction]], often a goal systolic of 140-160's | ||
*SBP >200 or MAP >150 | *SBP >200 or MAP >150 | ||
**Consider aggressive reduction w/ continuous IV infusion | **Consider aggressive reduction w/ continuous IV infusion | ||
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*SBP >180 or MAP >130 and NO evidence or suspicion of elevated ICP | *SBP >180 or MAP >130 and NO evidence or suspicion of elevated ICP | ||
**Consider modest reduction of BP (e.g. MAP of 110 or target BP of 160/90) | **Consider modest reduction of BP (e.g. MAP of 110 or target BP of 160/90) | ||
*Rapid SBP lowering <140 has been advocated with early research showing increased functional outcomes<ref>Anderson CS, Heeley E, Huang Y, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013; 368:2355-2365.<ref/>, but more recent work has shown now difference between <140 and <180<ref>Qureshi AI, Palesch YY, Barsan WG, et al. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med. 2016; ahead of press. DOI: 10.1056/NEJMoa1603460.<ref/> | |||
===Reverse coagulopathy=== | ===Reverse coagulopathy=== | ||
Revision as of 10:56, 27 June 2016
Elevating head of bed
- 30 degree elevation will help decrease ICP[1]
Blood Pressure
- Few studies on optimal management however many guidelines recommending moderate reduction, often a goal systolic of 140-160's
- SBP >200 or MAP >150
- Consider aggressive reduction w/ continuous IV infusion
- SBP >180 or MAP >130 and evidence or suspicion of elevated ICP
- Consider reducing BP using intermittent or continuous IV meds to keep CPP >60-80
- SBP >180 or MAP >130 and NO evidence or suspicion of elevated ICP
- Consider modest reduction of BP (e.g. MAP of 110 or target BP of 160/90)
- Rapid SBP lowering <140 has been advocated with early research showing increased functional outcomesCite error: Closing
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Fondaparinux or Rivaroxaban
- rFVIIa 2mg (40 mcg/kg)
- Or PCC 25-50 U/kg
- Don't give both 2/2 to prothrombotic effects
Dabigatran
- Idarucizumab (Praxbind): 5 grams IV (approved as of October 2015)
- rFVIIa 100 mcg/kg
- Or PCC 25-50 U/kg
- Consider DDAVP 0.3 mcg/kg
- Hemodialysis, if feasible