Treatment Of Acute Hemorrhagic Stroke Supportive Measures

Acute hemorrhagic stroke is considered to be an acute medical emergency. Initially, patients experiencing a hemorrhagic stroke should be transported to a neurointensive care unit. There is no proven treatment for ICH. Management is based on neurointensive care treatment and prevention of complications. Treatment should be provided to manage the needs of the critically ill patient including management of increased ICP, seizures, infections, and prevention of rebleeding and delayed cerebral ischemia. In those with severely depressed consciousness, rapid endotracheal intubation and mechanical ventilation may be necessary. BP is often elevated after hemorrhagic stroke and appropriate management is important to prevent rebleeding and expansion of the hematoma.46 BP can be controlled with IV boluses of labetalol 10 to 80 mg every 10 minutes up to a maximum of 300 mg or with IV infusions of labetalol (0.5-2 mg/min) or nicardipine (5-15 mg/h). Deep vein thrombosis prophylaxis with intermittent compression stockings should be implemented early after admission. In those patients with SAH, once the aneurysm has been treated, heparin maybe instituted.4,5

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