A 76-year-old right-handed patient has been admitted to the critical care unit with an intracerebral hemorrhage
A CT of her head reveals a large left parietal area bleed. Patient assessment includes T 98.7°F, P 98 beats/min and thready, R 8 breaths/min, and BP 168/100 mm Hg. The patient's initial treatment plan should involve
a. placing her in the Trendelenburg position.
b. administering an antihypertensive agent.
c. initiating induced hypertensive therapy.
d. intubation to support airway and breathing.
D
Intracerebral hemorrhage is a medical emergency. Initial management requires attention to airway, breathing, and circulation. Intubation is usually necessary. Blood pressure management must be based on individual factors. Reduction in blood pressure is usually necessary to decrease ongoing bleeding, but lowering blood pressure too much or too rapidly may compromise cerebral perfusion pressure, especially in a patient with elevated intracranial pressure. National guidelines recommend keeping the mean arterial blood pressure below 130 mm Hg in patients with a history of hypertension by moderate blood pressure reduction to a mean arterial pressure below 110 mm Hg. Vasopressor therapy after fluid replenishment is recommended if systolic blood pressure falls below 90 mm Hg.
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