Multiprofessional Critical Care Review: Adult 2024 (MCCRCA24ON)-7: Management of Severe Stroke and Subarachnoid Hemorrhage (Andrew M. Naidech, MD, MS)

7: Management of Severe Stroke and Subarachnoid Hemorrhage (Andrew M. Naidech, MD, MS)

Video Transcription

Video Summary

The video discusses severe stroke, subarachnoid hemorrhage, and intracerebral hemorrhage. The three main subtypes of spontaneous stroke in the United States are ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Stroke is a common cause of disability, and validated scales are typically required documentation in stroke centers to assess the severity of injury. For subarachnoid hemorrhage, the Hunt and Hess scale is used, while the ICH score is used for intracerebral hemorrhage. The NIH Stroke Scale score is typically required for ischemic stroke. Hypertension is the main risk factor for all types of stroke. Dysphagia is common and should be assessed before initiating oral feedings. Treatment options for stroke include medication like tissue plasminogen activator and endovascular treatment. Hemicraniectomy is an option for patients with large artery infarction. For subarachnoid hemorrhage, vasospasm treatment includes hypertension, hypervolemia, and hemodilution. Seizures, fever, and deep venous thrombosis are common complications. Intracerebral hemorrhage is scored using the ICH score, and management includes reversing coagulopathy and reducing blood pressure. Prophylactic phenytoin is not recommended.

Keywords

stroke

severe stroke

subarachnoid hemorrhage

intracerebral hemorrhage

validated scales

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