The non-contrast CT findings of a moderate intracerebral bleed, 3mm shift, and mass effect suggest Intracerebral hemorrhage (ICH). ICH refers to primary, spontaneous, non-traumatic bleeding in the brain parenchyma. The initial assessment will include measuring vital signs and a general physical examination. The National Institutes of Health Stroke Scale (NIHSS) score will be used to assess the neurological baseline severity score (Madangarli et al., 2019). The GCS will be applied to evaluate the patient’s level of consciousness.
Diagnostic orders will include a complete blood count (CBC), electrolytes, creatinine level, blood glucose, and coagulation studies.
Pharmacological interventions will aim at blood pressure management if the patient has an elevated BP. This will include administering short half-life antihypertensives with labetalol or nicardipine to avoid overshoot hypotension. If the patient is on anticoagulants like Warfarin, it will be discontinued, and he will be administered 10 mg of Vitamin K IV (McGurgan et al., 2019). Patients with ICH often cannot protect the airway because of reduced consciousness. Endotracheal intubation may be performed, but this intervention will be balanced against the risk of losing the neurologic examination (Madangarli et al., 2019). Pretreatment with lidocaine is recommended to blunt a rise in intracranial pressure (ICP) associated with intubation.
The anticipated clinical manifestations in this client include a decreased level of consciousness, headache, vomiting, seizures, and very high BP. The patient may also have a GCS score of 13 and below. Patients diagnosed with ICH should be admitted to a dedicated stroke or neuroscience intensive care unit. Thus, the plan will be to refer the patient to the stroke center for neurological consult and stroke management (McGurgan et al., 2019). Management of patients with ICH in a dedicated stroke unit is linked to decreased mortality and better functional outcomes than management in a general neurology ward.
References
Madangarli, N., Bonsack, F., Dasari, R., & Sukumari–Ramesh, S. (2019). Intracerebral hemorrhage: blood components and neurotoxicity. Brain sciences, 9(11), 316. https://doi.org/10.3390/brainsci9110316
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