A patient develops cerebral vasospasm after a ruptured cerebral aneurysm. Collaborative treatment should be focused on:
1. Reducing blood pressure
2. Dehydrating the patient
3. Concentrating red blood cells
4. Volume expansion
4
Rationale 1: Blood pressure needs to be maintained 10–60 mm Hg above baseline and/or kept between 150–200 mm Hg systolic blood pressure.
Rationale 2: Dehydration is not desirable as it will increase blood viscosity and increase the risk of clot formation.
Rationale 3: Keeping the RBCs concentrated is also not desirable as this can lead to the formation of blood clots.
Rationale 4: Vasospasm management is hypertensive, hypervolemic, and hemodilution (HHH) therapy. Volume expansion raises the blood pressure and decreases blood viscosity.
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