Stroke General Considerations

Links:

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage – A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

General management considerations for stroke: ischemic or hemorrhagic.

  • Intubate based on clinical status with consideration of various scales (GCS, HH, ICH, etc)
  • q1h neuro checks
  • keep head of bed 30°
  • Goal euglycemia (140-180)
  • Goal normothermia
  • Goal Na 135-145 and higher if cerebral edema is a concern.

Intracranial Hemorrhage

  • Epidural Hematoma – between bone-dura
  • Subdural hematoma – between dura-arachnoid
  • Subarachnoid Hemorrhage – between arachnoid- pia, cx:  aneurysm, AVMs, amyloid, vascuilitis, infectious emboli
    • “thunderclap headache” or “worst headache in my life”
    • Note “perimesencephalic SAH” is localized around the brainstem, usually venous in origin, considered benign
  • Intracerebral (Intraparencyhmal hemorrhage) – in parenchyma
    • Px with vomiting, severe headache, decreased consciousness, and often HYPERTENSIVE
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