ICH Intubated

Impression:

Acute Intracerebral Hemorrhage:

- Manifestations: ***
- Location: ***
- Presumed Etiology: ***
- PTA antithrombotics: ***

Plan:

Neurological:
- Neurological checks q1h
- Seizure, fall, aspiration precautions
- Head of bed at 30 degrees at all times
- SBP goal 100-140
- CTH:
- No free water, mix everything in NS as this can worsen cerebral edema
- PT/OT/ST consults initiated
- Meds:
Sedation with propofol at *** mcg/kg/h
Pain control with fentanyl at *** mcg/h
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Respiratory:
- On MV, mode ***
- Baseline CXR
- Suctioning q1-2 hours
- Meds:
- Duonebs q4h
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Cardiology:
- Continuous cardiac telemetry
- SBP goal 100-140
- Meds:
-Nicardine drip (target SBP < 160)
-Labetalol 10mg IV q4h prn
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Renal:
- Renal function normal
- Monitor daily electrolytes
- Foley with temperature probe for strict I&O monitoring in critical care setting
- Avoid hypotonic fluids as this can worsen cerebral edema
- Meds:
- IVFs as above
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Gastrointestinal:
- NPO
- Place Dobhoff tube for medication/nutrition; Abdominal X-ray to confirm placement ordered
- Start tube feeding with *** @ 10cc/hr and titrate to goal 50cc/hr as tolerated
- Hold TF for residuals > 300
- Last BM: unknown
- Meds:
- Docusate 100 mg PO TID
- Pantoprazole 40mg tab daily
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Endocrinology:
- FSBS q6hr while NPO/TF
- Check HgbA1c, TSH
- Meds:
- Insulin SS
- Hypoglycemia protocol
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Hematology:
- Monitor CBC daily
- SCDs for prophylaxis; no heparins given acute ICH
- Meds:
- None
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Infectious Disease:

- Current access: PIVs (placed)
- Keep normothermic, aggressive fever control as this worsens neurological outcomes
- Meds:
-APAP 500mg q6h prn fever > 38.3
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Prophylaxis:

DVT: SCDs, no anticoagulation in the setting of recent ICH
GI: pantoprazole, docusate
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Consults:
Neurosurgery
Physical therapy
Occupational therapy
Nutrition
Case Management
Social Work
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Discharge Planning:

Patient requires ICU level of care for monitoring of progression of cerebral edema.
Patient was discussed with the neurocritical care attending who agrees with current plan of management.