Hemorrhagic stroke

Management

1. Elevating head of bed to 30 degrees (if pt not hypotensive)
2. Keep MAP <130 during acute phase
3. If on coumadin with INR >1.5 consider reversal:
   1. Vitamin K 10mg IV gtt over 10min
      1. Small risk of anaphylaxis
      2. Takes 6-12hr to work
   2. FFP
      1. Usually need up to 6 units to bring INR to 1.2
      2. Be careful about volume overload in elderly
      3. Takes hours to work
   3. Prothrombin complex concentrate (20-50mg/kg IV x1)
      1. Fast-acting (10min) but expensive
4. If on ASA or clopidogrel:
   1. Desmopressin (0.3mcg/kg)
   2. Platelets

See Also

SAH

Source

EMcrit Podcast 17