5 • 714 Ratings
🗓️ 23 July 2020
⏱️ 31 minutes
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In this episode we cover one of the most fatal and moribund conditions we see regularly, Intracranial hemorrhage.
Etiology, diagnosis and treatment (of course we spend time on BP goals).
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0:00.0 | All right, welcome back to the Internet Book of Critical Care podcast. |
0:08.3 | I'm here with Adam Thomas and we're going to talk about intra-cerebral hemorrhage. |
0:11.6 | This is one of those main course chapters that you're going to come back to more and more. |
0:15.5 | And Josh, you're the hero we needed because you organized this very complex topic. |
0:20.0 | I think when we see that CT that shows the big, |
0:22.7 | nasty look and bleed, a lot of this comes to mind. How and when do I need to anticipate? Man, are they |
0:27.8 | on a doac? Do I reverse that? What's the plate lick out? What is the arbitrary blood pressure |
0:32.6 | number I'm going to pick? And when do I call my surgeons who's going to get mad at me on the phone? |
0:37.2 | So this is very important. And you even spice it up with some prognostication and differential stuff. |
0:42.1 | So let's get straight into the pathophys. |
0:44.2 | We're talking about intra-perankhamal hemorrhage here for the mainstay. |
0:47.6 | Tell me about the interplay between edema, pressure in, pressure out, and how that hematoma expands. We'll get to this a bit more with regards to blood pressure targets, but one phenomenon that |
0:56.9 | is important is certainly this is a bleed, it's a hematoma, and patients are all going to |
1:00.7 | present to us with the hematoma. |
1:02.2 | But there's a subset of about a third of patients where the hematoma expands substantially, |
1:06.3 | and that causes clinical deterioration, and it's associated with the worsening prognosis. So I think one question |
1:11.3 | is always, are there things that we can do to reduce hematoma expansion? And so far, it doesn't |
1:15.9 | seem like there are a ton of things, but maybe there are some things that we can do. On the flip |
1:19.0 | side of that, the hematoma compresses adjacent tissue, and that can cause poor profusion of |
1:23.3 | the pernum of around the hematoma. And I guess just, I think you've put it in the post, but I really want to specify in |
1:28.2 | and there's no magic number. |
1:29.3 | But is this like an early problem, a delayed problem or a late problem? |
... |
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