Hemorrhagic stroke early assessment: Difference between revisions
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==Early assessment== | ==Early assessment== | ||
[[intracerebral hemorrhage|intracerebral hemorrhage (ICH)]] is a medical emergency. Rapid diagnosis and management is crucial because early deterioration is common in the first few hours after ICH onset.<ref name="pmid18007267">{{cite journal| author=Moon JS, Janjua N, Ahmed S, Kirmani JF, Harris-Lane P, Jacob M et al.| title=Prehospital neurologic deterioration in patients with intracerebral hemorrhage. | journal=Crit Care Med | year= 2008 | volume= 36 | issue= 1 | pages= 172-5 | pmid=18007267 | doi=10.1097/01.CCM.0000297876.62464.6B | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18007267 }} </ref> | |||
===Prehospital Management=== | |||
*Provide ventilatory support | |||
*Provide cardiovascular support | |||
*Transport the patient to the closest facility | |||
**Plan for rapid transfer to a tertiary care center with crucial resources (such as neurology, neuroradiology, neurosurgery, and critical care facilities) | |||
===Emergent management may include=== | |||
Many centers have critical pathways developed for the treatment of acute ischemic stroke. However, few have protocols for the management of [[Intracranial hemorrhage|ntracranial hemorrhage (ICH)]]. | |||
*Emergent management may include:<ref name="pmid17667882">{{cite journal| author=Cooper D, Jauch E, Flaherty ML| title=Critical pathways for the management of stroke and intracerebral hemorrhage: a survey of US hospitals. | journal=Crit Pathw Cardiol | year= 2007 | volume= 6 | issue= 1 | pages= 18-23 | pmid=17667882 | doi=10.1097/01.hpc.0000256146.81644.59 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17667882 }} </ref> | |||
**Neurosurgical interventions for [[hematoma]] evacuation, external ventricular drainage or invasive monitoring and treatment of [[ICP]] | |||
**Blood pressure management | |||
**[[Intubation]] | |||
**Reversal of [[coagulopathy]] | |||
===General Monitoring=== | |||
Patients with ICH are frequently medically and neurologically unstable, particularly within the first few days after onset. | |||
Care of ICH patients in a dedicated neuroscience intensive care unit (dedicated stroke unit) rather than an intensive care unit | |||
General monitoring includes:<ref name=Anderson> Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, Lindley R, Robinson T, Lavados P, Neal B, Hata J, Arima H, Parsons M, Li Y, Wang J, Heritier S, Li Q, Woodward M, Simes RJ, Davis SM, Chalmers J; INTERACT2 Investigators. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368:2355– 2365. doi: 10.1056/NEJMoa1214609.</ref><ref name=Diringer> Diringer MN, Edwards DF. Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intrace- rebral hemorrhage. Crit Care Med. 2001;29:635–640.</ref> | |||
*Frequent vital sign checks | |||
*Neurological assessments | |||
*Continuous [[cardiopulmonary monitoring]] (cycled automated BP cuff, [[electrocardiographic]] [[telemetry]], and [[pulse oximetry]]) | |||
*Continuous intra-arterial BP monitoring (in patients receiving intravenous vasoactive medications) | |||
==References== | ==References== | ||
Latest revision as of 14:33, 14 November 2016
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Hemorrhagic stroke Microchapters |
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Diagnosis |
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Treatment |
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AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015) |
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AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (2012) |
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AHA/ASA Guideline Recommendation for the Primary Prevention of Stroke (2014) |
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AHA/ASA Guideline Recommendations for Prevention of Stroke in Women (2014) Sex-Specific Risk Factors
Risk Factors Commoner in Women |
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Case Studies |
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Hemorrhagic stroke early assessment On the Web |
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American Roentgen Ray Society Images of Hemorrhagic stroke early assessment |
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Risk calculators and risk factors for Hemorrhagic stroke early assessment |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Early assessment
intracerebral hemorrhage (ICH) is a medical emergency. Rapid diagnosis and management is crucial because early deterioration is common in the first few hours after ICH onset.[1]
Prehospital Management
- Provide ventilatory support
- Provide cardiovascular support
- Transport the patient to the closest facility
- Plan for rapid transfer to a tertiary care center with crucial resources (such as neurology, neuroradiology, neurosurgery, and critical care facilities)
Emergent management may include
Many centers have critical pathways developed for the treatment of acute ischemic stroke. However, few have protocols for the management of ntracranial hemorrhage (ICH).
- Emergent management may include:[2]
- Neurosurgical interventions for hematoma evacuation, external ventricular drainage or invasive monitoring and treatment of ICP
- Blood pressure management
- Intubation
- Reversal of coagulopathy
General Monitoring
Patients with ICH are frequently medically and neurologically unstable, particularly within the first few days after onset. Care of ICH patients in a dedicated neuroscience intensive care unit (dedicated stroke unit) rather than an intensive care unit General monitoring includes:[3][4]
- Frequent vital sign checks
- Neurological assessments
- Continuous cardiopulmonary monitoring (cycled automated BP cuff, electrocardiographic telemetry, and pulse oximetry)
- Continuous intra-arterial BP monitoring (in patients receiving intravenous vasoactive medications)
References
- ↑ Moon JS, Janjua N, Ahmed S, Kirmani JF, Harris-Lane P, Jacob M; et al. (2008). "Prehospital neurologic deterioration in patients with intracerebral hemorrhage". Crit Care Med. 36 (1): 172–5. doi:10.1097/01.CCM.0000297876.62464.6B. PMID 18007267.
- ↑ Cooper D, Jauch E, Flaherty ML (2007). "Critical pathways for the management of stroke and intracerebral hemorrhage: a survey of US hospitals". Crit Pathw Cardiol. 6 (1): 18–23. doi:10.1097/01.hpc.0000256146.81644.59. PMID 17667882.
- ↑ Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, Lindley R, Robinson T, Lavados P, Neal B, Hata J, Arima H, Parsons M, Li Y, Wang J, Heritier S, Li Q, Woodward M, Simes RJ, Davis SM, Chalmers J; INTERACT2 Investigators. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368:2355– 2365. doi: 10.1056/NEJMoa1214609.
- ↑ Diringer MN, Edwards DF. Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intrace- rebral hemorrhage. Crit Care Med. 2001;29:635–640.