Monday, October 11, 2021

Intracerebral Hemorrhage

emDocs - October 11, 2021 - By Daniel Bak and Matthew Siket 
Reviewed by: Andrew Grock; Alex Koyfman; Brit Long
Early and aggressive optimization of care can impact outcomes in ICH despite its intimidating prognosis. Initially, key steps include: a primary and secondary survey, identifying patients with potential ICH, and rapidly performing a NCCT brain. Once diagnosed, immediately elevate the head of the bed, keep SBP < 180 mmHg, reverse any coagulopathy, and consult neurosurgery. Surgical intervention, with a few important exceptions, remains reserved for those who have failed medical management, are rapidly deteriorating, or showing signs of obstructive hydrocephalus. Imaging findings and tools like the ICH scorecan aid in prognostication and communication with patients, family members, and colleagues. Maintenance of euglycemia and normothermia, and prevention of aspiration are basic, but meaningful strategies to optimize functional outcome. While treatment options for ICH remain largely conservative, recognizing that we have the power to affect outcomes is critical to ensuring that patients receive optimal care”