INTRACRANIAL HEMATOMA

Question 1

MANAGEMENT

Answer 1

1. CT HEAD NON CONTRAST
2. EMERGENCY NEUROSURGICAL CONSULT
3. REVERSE COAGULOPATHY
   Warfarin with elevated INR: Octaplex (PCC) 80mL (2000 U) + 10 mg Vit K IV, hold Warfarin, repeat INR

Rivaroxaban / Apixaban / Edoxaban: Octaplex (PCC) 80mL (2000 U) +/- 10 mg Vit K IV if elevated INR

Heparin: 1 mg Protamine per 100 units of unfractionated Heparin

Dabigatran: idarucizumab 5 g IV
fXa: andexamet, TXA
Thrombocytopenia: platelet transfusion

4. ICP MANAGEMENT
   Elevate head of bed to 30 degrees
   Mannitol 0.5-1 g/kg intravenous
   20 g / 100 ml
   3% hypertonic saline 100 mL intravenous
   Intubate, sedate, +/- paralyze
   Drain excessive CSF with intraventriculoperitoneal shunt

Question 2

DOCUMENTATION

Answer 2

SUBDURAL

Spectrum of presentations:
Often loss of consciousness or coma

Nausea and vomiting
Drowsiness and confusion
Seizures

Signs of herniation:
Ipsilateral pupil dilation
Cushing reflex (hypertension, bradycardia, breathing irregularity)

EPIDURAL

Transient loss of consciousness
THEN
Lucid Interval
FOLLOWED BY
Deterioration

N/V
Seizures
Signs of Herniation
Ipsilateral Pupil Dilation
Cushing Reflex (Hypertension, Bradycardia, Irregular Breathing)