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ICH and BP management

Spontaneous (non-traumatic) Subarachnoid Hemorrhage (SAH): Goal SBP < 140-160 mmHg Medication options: Labetalol IV 10mg boluses Nicardipine infusion Celvidipine infusion Avoid vasodilating agents like nitroprusside or nitroglycerin Spontaneous (non-traumatic) Intracerebral Hemorrhage: Goal SBP < 140 mmHg AHA / ASA guidelines (2015) give the following recommendation: “For ICH patients presenting with SBP between 150 and 220 mm Hg and without contraindication to acute

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PECARN Pediatric Head CT Rule

The PECARN head injury rule was derived in a population of patients younger than 18 years old with blunt head injury. 42412 patients were included in the study population with a goal of identifying patients at very low risk of clinically important traumatic brain injury (ciTBI) by history and exam criteria, obviating the need for CT imaging.  Child <2 yo

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Glascow Coma Scale (GCS)

 Eyes 4pt – Open spontaneously 3pt – Open to voice 2pt – Open to pain 1pt – No eye opening Verbal 5pt – Oriented, normal conversation 4pt – Confused, disoriented 3pt – Incoherent words 2pt – Incomprehensible sounds 1pt – No sounds Motor 6pt – Obeys command 5pt – Localizes pain 4pt – Withdrawal / flexion to pain 3pt –

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Antiplatelet Therapy and Intra-cranial Hemorrhage (ICH)

Treatment: Spontaneous ICH (intra-parenchymal) Studies suggest platelets may increase poor outcomes. (PATCH trial, etc) Note: trials excluded ruptured aneurysm, SDH and EDH Traumatic ICH (SDH, EPH) If neurosurgical intervention is NOT planned, recommendation is NOT to give platelets. If neurosurgical intervention IS planned within 24 hours: Obtain platelet function testing if possible If testing is normal, patient is anti-platelet resistant

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