Multiprofessional Critical Care Review: Adult (2023)-Case Study Discussion 4 (ICH)

Case Study Discussion 4 (ICH)

Pdf Summary

This document is a case study of a 66-year-old female who presents with a head injury after a fall and is on anticoagulation therapy. Initial labs show a left parietal subdural hematoma and elevated levels of Anti-Xa for apixaban. Concerned about thrombotic complications, no immediate treatment was given. However, a repeat CT scan shows interval growth of the hematoma, and the patient is treated with a 4-factor Prothrombin Complex Concentrate. The document also includes a guideline for the management of patients with spontaneous intracerebral hemorrhage on anticoagulation therapy, recommending immediate discontinuation of anticoagulation therapy and rapid reversal using specific interventions based on the type of anticoagulant. <br /><br />The document presents two multiple-choice questions related to the management of intracerebral hemorrhage. The first question asks about the most appropriate intervention for a patient with a small hemorrhage in the right frontal lobe and a history of atrial fibrillation treated with apixaban, with the correct answer being Prothrombin Complex Concentrate. The second question asks about the most appropriate systolic blood pressure goal for treatment in a patient with an acute right frontal hemorrhage, with the correct answer being 140 mm Hg.<br /><br />Discussion points mentioned in the document include the threshold for CT scanning in patients on anticoagulation therapy, the diagnosis in non-communicative patients, the risks and benefits of early reversal of anticoagulation, the choice of agents for reversal, and the importance of neuromonitoring.

Keywords

head injury

fall

anticoagulation therapy

subdural hematoma

Anti-Xa

thrombotic complications

CT scan

Prothrombin Complex Concentrate

intracerebral hemorrhage

systolic blood pressure goal

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