Treatment/Management of Acute Hemorrhagic Stroke (based on Sinai protocol)

Labs: FS, electrolytes, CBC, coags, cardiac enzymes

Radiology: CT head

Maintain SBP between 160-180 and MAP <130 using labetalol, nicardipine, or clevidipine

If Hypotensive maintain SBP >90 with fluids before starting vasopressors consider norepinephrine or phenylephrine infusions

If intracranial HTN: analgesia and sedation, mannitol, hypertonice saline,

Consider seizure prophylaxis (in patients not following commands, with cortical involvement, evideince of midline shift on head CT, or going to the OR for neurosurgery): fosphenytoin

Maintain euglycemia (serium glucose >70 and less than 185

Reverse anticoagulation: warfarin (IV vit K, PCC), liver failure with known coagulopathy or elevated PT/INR(kit K IV, PCC and 2 units FFP), recent heparin (give protamine IV), lovenox (protamine), reversal of platelet dysfunction (DDAVP and 6 units of platelets), renal disease with increased Cr (DDAVP), thrombocytopenia <50K (platelets)

If SAH then give fosphenytoin, nimpodipine, goal SBP 90 to 160