What is the initial treatment in the Emergency Department (ED) for a 91-year-old female with intracranial hemorrhage (ICH) causing midline shift prior to transfer?

From the Guidelines

Initial Treatment for Intracranial Hemorrhage

Initial treatment for a 91-year-old female with intracranial bleeding causing midline shift in the Emergency Department (ED) prior to transfer should focus on stabilizing the patient and reducing intracranial pressure (ICP).

• Administration of mannitol 1g/kg IV over 30 minutes, followed by a maintenance dose of 0.25-0.5g/kg IV every 4-6 hours as needed, may be considered to reduce ICP 1.
• Additionally, intubation and mechanical ventilation should be initiated to maintain a target PaCO2 of 35-40 mmHg, and seizure prophylaxis with levetiracetam 500mg IV every 12 hours may be administered 1.
• Hypertension should be managed with titrated doses of nicardipine or labetalol to maintain a systolic blood pressure < 160 mmHg.
• Before transfer, other preparations should include:
  • Checking arterial blood gases to validate oxygenation and end-tidal carbon dioxide 1
  • Ensuring haematology tests such as full blood count and coagulation screen are performed 1
  • Considering blood, fresh frozen plasma (FFP), and cryoprecipitate transfusion and tranexamic acid if significant haemorrhage has occurred 1
  • Maintaining normothermia (36-37°C) and using active warming if the patient is hypothermic 1
  • Confirming correct placement of tracheal tube and gastric tube if present 1
  • Loading with anticonvulsant agents such as levetiracetam if the patient has had a seizure 1 It is crucial to prioritize the patient's stability before transfer, as secondary brain injury can occur due to poor execution of transfer 1.

From the Research

Initial Treatment for Intracranial Hemorrhage (ICH) in the Emergency Department (ED)

There are no research papers provided that directly address the initial treatment in the ED for a 91-year-old female with intracranial hemorrhage (ICH) causing midline shift prior to transfer.

Relevant Information

• The provided studies discuss various medical conditions and treatments for elderly patients, but none specifically focus on the initial treatment for ICH in the ED [@\1@, @\2@, @\3@, @\4@, @\5@].
• The studies cover topics such as hypertension treatment in elderly patients [@\1@], rare tumor cases [@\2@], anesthesia techniques for elderly patients [@\3@], carotid artery tortuosity [@\4@], and linear IgA bullous disease [@\5@].
• None of the studies provide guidance on the initial treatment for ICH with midline shift in the ED setting.

Available Data

• The studies do not offer relevant data on the treatment of ICH with midline shift in elderly patients in the ED [@\1@, @\2@, @\3@, @\4@, @\5@].
• The information provided is not directly applicable to the initial treatment of ICH in the ED.