Critical Care Scenarios Episode 13: Intracerebral hemorrhage and elevated ICP (part 1)
Aug 9, 2020
Dive into the urgent world of neurocritical care, where the challenges of managing acute ischemic strokes are unraveled. Discover the vital role of the Glasgow Coma Scale and CT scans in assessing brain injuries. Learn about the intricate evaluation of intubated patients and the importance of family input for understanding a patient's history. Explore the evaluation and management of intracerebral hemorrhage, highlighting critical decisions in neurosurgery and monitoring strategies for elevated intracranial pressure.
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DOAC Reversal
- Reverse apixaban, a DOAC, with four-factor PCCs (Prothombin Complex Concentrates) like K-Centra.
- Consider Andexanet if available, but it's expensive with questionable efficacy, compared to PCCs or FFP.
INR and Apixaban
- Apixaban usually elevates INR slightly (1.1-1.3).
- An INR of 2 is high, suggesting a possible secondary coagulopathy like malnutrition or other medications.
Blood Pressure Control
- Control hypertension in hemorrhagic stroke patients to prevent further bleeding.
- Target systolic BP under 140 or 160, using PRN labetalol or a nicardipine drip.