BUMC Basics.pdf - Anesthesia Home

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Additional studies — MRI brain with and without contrast
with seizure protocol, need LP
Treatment:
1. Intubate if indicated
2. Ativan 0.1mg/kg IV at 2mg/min; if no response, then
3. Dilantin 20mg/kg IV at 50 mg/min (or Cerebyx 20mg
p.e./kgIV at 150mg p.e./min); if no response, then
4. Additional IV dilantin or cerebyx (5-10mg/kg) bolus; if
still no response, and continued sz>one hr, or
hyperthermic, then definitely needs intubation if not
already done, EEG monitoring, and ICU admission;
then,
5. Phenobarbital 20mg/kg IV at 50-75 mg/min initially,
then additional 5-10 mg/kg bolus if still seizing; if no
response then
6. Sedate (versed 0.1mg/kg, then run at 10mcg/kg/min
or propofol 2mg/kg, then run at 5mg/kg/hr)
7. Additional phenobarb prn
8. Pentobarb coma as last line of treatment with
continuous EEG monitoring in place. Titrate
pentobarb to burst suppression with 1 to 3 bursts per
minute.
Neuro consult, EEG monitoring (if sedated/unclear status)
CVA: Hemorrhagic
STROKE MANAGEMENT
• Intracranial or SAH
• Usually intubated either 2/2 AMS, elective
hyperventilation, or post-craniotomy/repair/ventric
placement.
Diagnostic studies — Labs including CBC, CMP, PT/INR
and urine drug screen, non-contrast CT head, LP to check for
xanthochromia if no evidence of SAH on CT, but suspicion still
high
Treatment:
1. Stat neurosurgery consult to review films/patient
2. Admit using Hemorrhagic stroke protocol