Protocols - Hemorio

BASIC ELEMENTS IN ROUTINE FOR CEREBRAL INFARCTION:
NEUROLOGICAL COMPLICATIONS:
The principal neurological complications from cerebral infarction at acute phase are:
- Cerebral edema and intracranial hypertension (HIC)
- Hydrocephalia
- Hemorrhagic transformation
- Convulsive crisis
- Early recurrence: (see picture below)
CLINICAL FACTORS AND PREDICTIVE LABS FOR DCV
CLINICAL FACTORS PREDICTIVE LABS
STROKE HF
Snoring or nocturne apnea
Amygdala Hypertrophy
Meningoencephalitis by HPP
23
Low fetal Hb
High Hemoglobin
Leucocytose
Homocysteine deficiency
CEREBRAL EDEMA AND INTRACRANIAL HYPERTENSION TREATMENT
- Do not use corticoid
- Do not sedate the patient
- Elevate headboard at 30 o
- Orotracheal intubation in case of hyperventilation and/or PCO 2 of + 30 mmHg
- PIC monitoring, in selected cases (Coma, major hemispherical lesions irresponsive to treatment).
- Osmotic therapy on patients with HIC neurologic deterioration (10% of the cases)
Mannitol 20%
Furosemide
DIAGNOSTIC
- Hemorrhagic vs ischemic
- Topographic
- Associated vascular factors
COMPLEMENTARY EXAMS
- Glycemia - Blood count
- Coagulogram - Electrolyte
- Renal function - Lipidogram
- Enzimas miocárdicas
MONITORING
- Neurologic
- PA e TAx
- Frequence cardiac
- ECG (to
admission)
PATIENT
EVALUATION
1-2 g/kg/24h in intervals of 4 h, infusion at 4 to 5 mL/min, for at least 3 days.
To take off gradually maintaining interval between doses.
Use only on emergency cases (ex. Immediate transtentoyal hernia).
Dose: 70 mg or 7 ml IV slow. Don’t use to maintenance
CT
Cervical vases
duplex scan
cervicais
NOTE
- Breathing - Peneumonia
- Hydration - Pulmonary edema
- Swallowing - TVP
- Alimentation - ITU
- Sepse - Gangrene
TREATMENT
- Hydrate 1.5 to 2 L (Do not use pure
glucose)
- Insulin if Gli ≥ 150-180 mg%
- Hypertension: indication and drugs
- Heparin/heparinoids-DVT prevention/ EP
- Oxygen, if saturation ≤ 92-95%
- Antipyretics, if rate > 37-37,5o Cl
- AAS 160-300 mg/day
- Culture and antibiotic therapy if there
is infection)
- UTI em complicações graves
COMORBIDITY
- Diabetes
- HAS
- Epilepsy
- Síndr de secr inapropr ADH
- Heart failure