Intra ventricular hypertensive haemorrhage
A 60 years old male , a chronic smoker , and known hypertensive- presented with sudden deterioration in consciousness and O / Examination- B.P - 230 mm of Hg GCS - E3 V3 M5 NCCT scan was done Approach to the patient
what patient needs is urgent ventriculostomy and continuous evd..with intensive care, aed, ppp blockers, nsaid, antibiotic coverage, oxygen support, prevention of airway blockage and chest complication, bedsore and other complications...eventually patient can survive..mannitol, ladi, diuretics, steroids etc don't help but will harm and are contraindicated...angio is not needed at this stage as this is hypertensive blwed and not aneurysmal.. shifting critical patients for unnecessary investigations is actually harmful... such cases require very expert neurosurgical and critical care consultants to deliver the desired outcome...we see most patients worsening due to inexpert managment by non neuro specialities and then they are referred after iatrogenic worsening whereby the overall outcome is far worse and a much added expense to the patient and family...my message to medica fraternity... DONT TREAT SUCH CASES ARBITRARILY, INVOLVE A NEUROSURGEON FROM DAY 1 AS TEAM LEADER
what patient needs is urgent ventriculostomy and continuous evd..with intensive care, aed, ppp blockers, nsaid, antibiotic coverage, oxygen support, prevention of airway blockage and chest complication, bedsore and other complications...eventually patient can survive..mannitol, ladi, diuretics, steroids etc don't help but will harm and are contraindicated...angio is not needed at this stage as this is hypertensive blwed and not aneurysmal.. shifting critical patients for unnecessary investigations is actually harmful... such cases require very expert neurosurgical and critical care consultants to deliver the desired outcome...we see most patients worsening due to inexpert managment by non neuro specialities and then they are referred after iatrogenic worsening whereby the overall outcome is far worse and a much added expense to the patient and family...my message to medica fraternity... DONT TREAT SUCH CASES ARBITRARILY, INVOLVE A NEUROSURGEON FROM DAY 1 AS TEAM LEADER
Ref to interventional neurologist,/ neurosurgeon if suspecting aneurysmal bleed. Gradual reduction in BP, keeping systolic BP around 150mmhg. Adv MRI angio. Anticonvulsant agents and steroids initially. See for coagulation profile.
Intracerebral hemorrhage at substentia nigra rt side leakage in rt ventricle Midline shift is noted Pt is uncontrolled hypertensive Poor GCS Lower bp gradually Tab metaprolol 50mg +chlorthalidone 12.5mg Tab cilnidipine 10mg Diuretic inj lasix Inj dexamethasone Inj Ceftriaxozone Monitoring of vitals I/O chart Opinion of neurosurgeon May need decompression
आयुर्वेद के अनुसार रोगी वात व्याधि से ग्रस्त है। चिकित्सा संबंधी योग,,,,, बृहत वात चिंतामणि रस स्वर्ण युक्त 1 रत्ती एकांग वीर रस 2 रत्ती रस राज रस 1 रत्ती शहद में मिलाकर सुबह-शाम सेवन कराएं सर्पगंधा घन वटी 2 सुबह शाम जल से सेवन कराएं। महारास्नादि क्वाथ 25 ग्राम सुबह-शाम खाने के बाद दें। योग परिक्षित है। पिछले 40 वर्ष से प्रयोग कर रहा हूं।
Reduce icp. Control bp&evd(external ventricular drainage) may help
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