By Jennifer A Frontera
From vital features of the actual exam to imaging experiences to remedies and dosage instructions, choice Making in Neurocritical Care presents a ...
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Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19(5):604–7. Pearls and Pitfalls • All practitioners should maintain a high index of suspicion for subarachnoid hemorrhage, even when the initial CT is negative. A lumbar puncture should be performed to assess for CSF xanthochromia in CT-negative patients. • Early treatment of a ruptured aneurysm is strongly recommended to prevent the mortality and morbidity associated with rerupture. • Symptomatic vasospasm is a significant contributor to morbidity and must be treated early and aggressively.
Assess for history of cancer, smoking, weight loss, or tobacco use (metastatic disease). • Assess for history of dementia (amyloid) or trauma. ). • Alcohol or illicit drug use should be determined, as should use of warfarin, antiplatelet, or antithrombotic therapy. • Liver disease, renal disease (uremic platelets), and hematologic disease history should be obtained. • Decreased mental status is more common with ICH than ischemic stroke, and vomiting is more common with ICH than with either subarachnoid hemorrhage (SAH) or ischemic stroke.
Early seizures are not associated with worse outcomes. HyperNone ventilation Prophylactic hyperventilation (PaCO2 Յ25 mm Hg) is not recommended. None Hyperventilation is recommended as a temporizing measure for the reduction of elevated ICP. Hyperventilation should be avoided during the first 24 h after injury when CBF is often critically reduced. If hyperventilation is used, jugular venous O2 sat or brain O2 tension measurements are recommended. Keep PaCO2 35–40 mm Hg if the ICP is otherwise controlled.
Decision making in neurocritical care by Jennifer A Frontera