tailieunhanh - Neurological Emergencies - part 7

Động mạch thực hiện của các tổ chức không thường xuyên điều trị Sah có thể không đầy đủ về mặt kỹ thuật và yêu cầu lặp đi lặp lại khi chuyển đến nhà giải phẫu thần kinh. • Huyết áp phải được giám sát chặt chẽ và kiểm soát Sah sau đây. | MANAGEMENT OF SUBARACHNOID HAEMORRHAGE best to allow the surgeon who will be caring for the patient to arrange for the diagnostic arteriogram to be performed at the institution where the patient will undergo surgery to repair the aneurysm. Arteriography performed by institutions infrequently treating SAH may be technically inadequate and require repetition upon transfer to the neurosurgeon. Blood pressure must be closely monitored and controlled following SAH. Hypertension will increase the chance of catastrophic rebleeding. Blood pressure control should be initiated immediately upon diagnosis of SAH. Preoperative medications include prophylactic anticonvulsants calcium channel blockade corticosteroids and antihypertensives as needed. We do not initiate antifibrinolytic therapy unless surgery is not considered within 48 hours of the initial SAH. Medications that can be initiated prior to transfer to a neurosurgeon include - dexamethasone 4 mg IV six hourly - nimodipine 60 mg orally four hourly - phenytoin 10 mg kg IV load then 100 mg orally IV three times daily. A frequent source of diagnostic difficulty for the neurosurgeon lies in the use of excessive amounts of narcotic analgesics prior to transfer to the neurosurgical service. Although pain control facilitates blood pressure control the ability to grade accurately the patient s level of consciousness has significant impact on the timing of surgery. Clinical grading obscured by large doses of narcotic analgesics makes surgical planning more difficult. Send all x ray films MRI scans and lab work with the patient to avoid needless repetition. We perform surgery or endovascular coiling to obliterate the ruptured aneurysm as soon as possible after the onset of SAH. Poor grade patients grades 4 and 5 are treated non-operatively or neurointerventionally until their clinical condition improves. Postoperative care is directed towards supportive care and complication recognition and treatment. Frequent postoperative .