What drugs should be given?

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pheonxfire

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If a patient has a suspected brain hemorrhage, what drugs would or should be given for both treatment and for transport?

Just trying to get an idea of what other people think should be done (had a patient like this during an ER shift)
 
Not enough information. Different pt's require different meds for same diagnosis. How did the pt present?

GCS? Level of consciousness? Pain? How much? BP? HR?

With a GCS <9, or <14 with significant enough lateralizing signs, I'd RSI them.

Symptoms of pain, or even signs of pain with GCS 3T, I'd treat the pain. Fentanyl works great.

If Systolic BP is >180 or Diastolic > 120, I'd treat the BP with something like labetalol. Some ER docs like something else.

The thing is you need to be aggressive, but not too aggressive. The term "iatragenic" is a four letter word.

Also, suspected differs from confirmed. The pt needs to be CT's pdq. Because if it's ischemic and confirmed less than 3 hrs with no contraindication, there's a good chance you'll see some tPA work its magic.
 
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here at my service the 3 hour window no longer applies to us. Vanderbilt, St. Thomas and Skyline in nashville have new procedures that are working as far out as 16 hours with postive results. No age restricition either. we sent a 95 year old woman with majior deficits. Majior facial droop..one sided paralysis and could not talk and she arrived at skyline 11 hours from onset. 95% recovery from new procedures and experimentally drugs. She was back at home doing everything she did before within month and a half. Basically if we suspect stroke we fly em if possible.
 
I am not commenting on any of the medications that are used in hospital (Our side anyway).

If i read (& understand) your question correctly, No there is no sort of "anti brain heamorage" drug. We treat these injuries: ABC! I.E. use intubation medications if the patient needs intubation, Fluids titrated against circulation status, and other medication as the need arises, sush as sedation for the combative patients.

It is difficuilt to say that there is a single recipy for all brain heamorage patients, because there are many types and they do not all present the same, and are not all treated the same (In hospital).
 
Ops Paramedic said:
I am not commenting on any of the medications that are used in hospital (Our side anyway).

If i read (& understand) your question correctly, No there is no sort of "anti brain heamorage" drug. We treat these injuries: ABC! I.E. use intubation medications if the patient needs intubation, Fluids titrated against circulation status, and other medication as the need arises, sush as sedation for the combative patients.

It is difficuilt to say that there is a single recipy for all brain heamorage patients, because there are many types and they do not all present the same, and are not all treated the same (In hospital).
Click to expand...

Very true, Ops.
 
I agree that it is very hard to determine some kind of baseline of treatment for these types of patients. I just found this one to be particularly interesting because I had a patient like this during one of my hospital shifts, things were going so fast and I tried to catch as many treatments as possible. But I was just curious to see how others treated this type of patient, to see if they had anything in common.
 
EtCO2 monitoring, being prepared for siezures. ' tis all we have in our world for bleeds worth anything.
 
(EMT-B)
15L 02 Via NRB
Unless they aren't breathing which they probably wouldn't be. BVM!
 
Topher38 said:
(EMT-B)
15L 02 Via NRB
Unless they aren't breathing which they probably wouldn't be. BVM!
Click to expand...
Actually high flow oxygen level is considered contraindicated as oxygen causes vessel receptor site to vasoconstrict (which appears to be a good thing, but can cause ischemia); rather many are going to 3-4 lpm per nasal cannula.

R/r 911
 
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