Management of Spontaneous ICH Corey Heitz, MD Director, Undergrad Med Ed Assistant Professor, Emergency Medicine.

Slides:

Advertisements

Similar presentations

Update on Stroke Management

Advertisements

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

Rapid Reversal of Warfarin Therapy in Patients with Intracranial / Intraspinal Bleeding Mount Auburn Hospital Blood Bank, Emergency Department, Critical.

Educational Event 23rd & 24th January 2013

Stroke Workshop Case Scenario.

Prosthetic Valve; Anticoagulation After ICH Dr.Tahsin.N.

In-Patient Management of Hyperglycemia Rey Vivo, MD Assistant Professor of Medicine Texas Tech University Health Sciences Center.

Heather M. Prendergast, MD, MPH EMRA/FERNE Case Conference: Legal Issues in the ED Management of Acute Ischemic Stroke Patients.

TPA in Stroke: What's All the Fuss?. FERNE Brain Illness and Injury Course.

TPA… SMART or not SMART? That is the Question. Sarah Parker, MD.

Project: Ghana Emergency Medicine Collaborative

Disclosures: Maximo C. Kiok, M.D. Medical Director of Stroke Program Trinity Health System.

STROKESTROKESTROKESTROKE. Why Change? Improve Mortality Improve Mortality Devastating and Life Altering Devastating and Life Altering Cost expense of.

INTRACEREBRAL HEMORRHAGE UPDATE

Question: How should we manage periprocedural anticoagulation? Paper: Management of Antithrombotic Therapy in Patients Undergoing Invasive Procedures Todd.

Edward P. Sloan, MD, MPH, FACEP Diagnosing & Treating Emergency Department CNS Hemorrhage Patients.

Cerebrovascular Disease

Journal Club: The ED Management of Intracerebral Hemorrhage Patients Journal Club: The ED Management of Intracerebral Hemorrhage Patients Nils G. Wahlgren,

Scott Silvers, MD, FACEP Treating ED Ischemic Stroke Patients: NIHSS Approximation & Elevated BP Management.

Medications that impact bleeding By Nino Lalaiants Inesa Legrian NYCCT 2012.

FAST EXAM IN PEDIATRIC PATIENTS Evidence in the ED March 5, 2014 Sarah Cavallaro PGY-3.

Richard Shih, MD, FACEP The Diagnosis and Management of ED Headache Patients: When Must Cranial CT and LP Both Be Performed in Order to Exclude the Diagnosis.

Edward P. Sloan, MD, MPH, FACEP ED Hemorrhagic Stroke Patient Management: What Role for Operative Intervention & Factor VIIa?

Anticoagulation in Acute Ischemic Stroke. TPA: Tissue Plasminogen Activator 1995: NINDS study of TPA administration Design: randomized, double blind placebo-controlled.

By Dr./ Hassan Ahmad Hashem Neurology MD

Brain Single-Photon Emission CT With HMPAO and Safety of Thrombolytic Therapy in Acute Ischemic Stroke Proceedings of the Meeting of the SPECT Safe Thrombolysis.

Journal Club: The ED Management of Intracerebral Hemorrhage Patients Journal Club: The ED Management of Intracerebral Hemorrhage Patients Edward P. Sloan,

E. Bradshaw Bunney, MD Diagnosing & Treating Emergency Department CNS Hemorrhage Patients.

Edward P. Sloan, MD, MPH, FACEP Emergency Department Patient Hypertensive Emergencies: Published Guidelines, Articles, & Their Findings.

FERNE/MEMC Session: Treating Ischemic Stroke in the 3 – 4

ACEP Clinical Policy: ACEP Clinical Policy: Critical Issues for the Evaluation and Management of Adult Patients Presenting With Seizures William C. Dalsey,

Jonathan A. Edlow, MD, FACEP Transient Ischemic Attack Patient Update: The Optimal Management of Emergency Department Patients With Suspected Cerebral.

Edward P. Sloan, MD, MPH, FACEP Diagnosing & Treating ED CNS Hemorrhage Patients.

A Case of a Thunderclap Headache Andy Jagoda, MD, FACEP.

Care of the Anti-coagulated Trauma Patient Julie Mayglothling, MD, FACEP Emergencies in Medicine March 8 th, 2012.

Intracerebral Haemorrhage. Clinical Context ICH accounts for up to 15% of first-time strokes and is associated with a 30-day mortality rate between 35%

Trials for Patients on Neuro-Intensive Care: Removing the Headache IA Anderson, CJ McMahon, J Timothy _ Department of Neurosurgery, Leeds General Infirmary,

Michelle Biros, MD Evaluation & Management of Severe Traumatic Brain Injury Patients with Suspected Elevated ICP.

Management OF INTRACEREBRAL HEMORRHAGE

Stroke and the ED Kurian Thomas, MD Department of Neurology.

FERNE/EMRA How do we treat ICH patients with an elevated INR Andy Jagoda, MD, FACEP Professor and Vice Chair Department of Emergency Medicine Mount Sinai.

Role of Factor Concentrates in Perioperative Coagulopathies Dr Neville Gibbs Department of Anaesthesia Sir Charles Gairdner Hospital.

Evidence in the ED Byron Drumheller, MD Penn Emergency Medicine.

Najwa Al-Bustani Neurology PGY-3. INTRACEREBRAL HEMORRHAGE: Bleeding into the parenchyma of the brain that may extend into the ventricles and, in rare.

Treatment of Ischaemic Stroke The American Heart Association American Stroke Association Guidelines Stroke. 2007;38:

Anticoagulations and Coagulants

1 Ultra-rapid management of oral anticoagulant therapy- related surgical intracranial hemorrhage Intensive Care Medicine (2007) 33: Zohra Daw, MD,

Edward C. Jauch, MD, MS FACEP 1 Research Horizons in the Acute Management of ICH.

Peri-Operative anticoagulation /antiplatelet therapy A Shift in Paradigm BMHGT04/29/09.

Drugs Susan Louw Haematology Registrar. 4 Questions to ask: Can I stop? (What is the risk of thrombosis?) Should I stop? (What is the risk of bleeding?)

General principles for preventing high INR Simple dental or dermatological procedures may not require interruption to warfarin therapy. Simple dental.

Agents Affecting Blood Clotting

Subarachnoid hemorrhage diagnosis-what to do J. Stephen Huff, MD Fourth-Year student elective director Professor of Emergency Medicine and Neurology University.

Brain waves or brain drain Interactive case discussion Dr Jenny Vaughan and Dr Richard Perry Charing Cross Hospital Hammersmith Hospital Imperial College.

Radiology Training Course. Timing of Imaging Studies.

Simon Howard Medical Management of Acute Stroke. Fast Recognition of Stroke With sudden onset neurological symptoms: 'FAST' should be used to screen for.

ACUTE STROKE TREATMENT: An introduction Dec.2014

April 23, 2015 Mini-Lecture Nathan King M.D. Anticoagulation Reversal Part 1: Warfarin.

Adult Stroke 2010 AHA Guidelines for CPR and ECC

Neurological Emergency Treatment Trials Network Six questions about the new network Robert Silbergleit, MD University of Michigan.

Rapid Reversal of Warfarin Therapy in Patients with Intracranial / Intraspinal Bleeding Mount Auburn Hospital Blood Bank, Emergency Department, Critical.

Warfarin Toxicity Treatment & Management

UNDER PRESSURE: Intracerebral Hemorrhage

When Not to Intervene in Acute Stroke or

Anticoagulation in Atrial Fibrillation

Performance Improvement: Emergency Management in Acute Cerebrovascular Patients Current US Guidelines Lisa A. Shultz, MD Medical Director, Lourdes Stroke.

Approach to Hemorrhagic and Ischemic Strokes

Anticoagulant Reversal

Intracerebral Hemorrhage

Presentation transcript:

Management of Spontaneous ICH Corey Heitz, MD Director, Undergrad Med Ed Assistant Professor, Emergency Medicine

Disclosures none

Objectives Become familiar with 2015 ICH guidelines Discuss evidence basis for main recommendations Provide initial management to ICH pts

I take coumadin

What are the questions? Best imaging Blood pressure control Stop the bleeding Seizure prophylaxis Evacuation/drainage

Imaging CT and MRI are equally sensitive (I, A) MRI is better for subacute blood CTA/MRA/venography (IIb, B) SAH Calcifications at margins Venous hyperattenuation Unusual shape Edema out of proportion Lobar hemorrhage <55yo No history of htn

What are the questions? Best imaging Blood pressure control Stop the bleeding Seizure prophylaxis Evacuation/drainage

Blood Pressure Control Lowering BP to 140mmHg is safe (I, A) Lowering BP to 140mmHg may improve functional outcomes (IIb, C) If >220mmHg, IV infusion may be effective (IIb, C) What drug?

What are the questions? Best imaging Blood pressure control Stop the bleeding Seizure prophylaxis Evacuation/drainage

I’m having a seizure!!

Seizure management Treat seizures (I, A) Treat patients with AMS and EEG positive (I, C) Continuous EEG probably recommended if AMS out of proportion to ICH (IIa, C) Do not prophylax (III, B)

What are the questions? Best imaging Blood pressure control Stop the bleeding Seizure prophylaxis Evacuation/drainage

Stop the bleeding! Replace factors and/or platelets (I, C) Hold VKA, give IV vit K, correct INR (I,C) PCCs are faster and fewer side effects (IIb, B) rFVIIa not recommended (III, C)

Stop the bleeding! NOACs: PCCs or rFVIIa are options (IIb, C) Activated charcoal if <2 hrs since last dose (IIb, C) Protamine if on heparin (IIb, C) Use of platelets unclear if using antiplatelets

What are the questions? Best imaging Blood pressure control Stop the bleeding Seizure prophylaxis Evacuation/drainage

Evacuation/Drainage Hydrocephalus with AMS (IIb, B) GCS <8, herniation, significant IVH Cerebellar bleeds w herniation, decompensation need surgery (I, B) Early evac not better than waiting for decomp (IIb, A)

What are the questions? Best imaging Blood pressure control Stop the bleeding Seizure prophylaxis Evacuation/drainage

Others Swallow studies should be performed Initial severity scale (NIHSS or other; I, B) Avoid hyper/hypoglycemia No role for corticosteroids

Control BP No seizure meds Reverse INR Initial severity Swallow screen Admit to ICU/neuro unit