Things to note:
- If indicated, refer the patient to neurochirurgical opinion. Management support.
- Hydration and nutrition optimization- insert nasogastric tube if patient is unable to swallow.
- Take precautions to ensure that the airway is open when the patient is unaware.
- Physiotherapy and good care for nursing.
- Consider rehabilitation, if necessary, for suitable patients.
- In the acute setting, ECG excludes the acute coronary ischaemic event.
- Meningovascular syphilis excluding RPR.
DVT heparin prophylaxis can be contraindicated due to increased bleeding risk.
In patients with increased intracranial pressure, the following measures should be used:
- Head elevation and position,
- Air and ventilation control,
- Sedation and analgesia,
- Fever control,
- Hypertension control and
- Seizure prevention.
At the moment, there is no evidence to support the use of hyperventilation in this environment.Medical Treatment:
For increased intracranial pressure only:
* mannitol 15-25%, IV 0,25-1 g / kg administered over 30-60 minutes.
- Neurological response monitoring and urine output.
- Do not repeat 6-8 hours or more.
- Pay attention to hypovolaemia and electrolyte disorders, in particular hypokalaemia.
At the moment there is no evidence supporting the use of hypertonic saline infusion. In this setting the corticosteroids used have a harmful effect.