Cerebellar Bleed Management @ your institution

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Hey folks, I'm giving a talk on the ED management of Cerebellar Bleeds. The case is of a guy in his 60s presenting with a gait disturbance/persistent vomiting. He was given a couple full doses of aspirin by his wife before coming the ED with a SBP >200. NCHCT showed a cerebellar bleed.

I wanted to know what others around the country do on the following discussion points (i've included our management/goals):

1. BP management - your choice of agent and algorithm (target)
-A line, nicardipine gtt, target < 160
2. +/- Platelets
-1 unit (4 packs) given
3. other interventions?
4. prognosis
-this one did relatively well: a few days in the NSGY ICU on ICP/BP monitor, stable evolution of hematoma on f/u, d/c to rehab

 

[Jeff698]

I like labetolol and my goal is reduction by 20%.

Take care,
Jeff

 

[southerndoc]

Our neurosurgeons like nicardepine, although it's has a very weak association with worse neurologic outcome. They like it because it gets BP down fast. They want a target BP of 140/90 or less with any bleed.

Doubt I would've given platelets. If the patient was also on Plavix, then yea, it's more of a consideration.

 

[dchristismi]

I like cardene for bleeds. Easy to titrate, but depending on how high it was, start with 20% reduction. SBP of 230 is a huge drop to 160. Coming from 200 is not as bad.

Platelets take FOREVER at my shop.
Next, call the transfer center. I don't have a neurosurgeon, and have to transfer all bleeds (unless the family wants hospice - an option rarely exercised.) If NSG wants platelets, fine, but the chopper is often faster than the bloodbank. Going by ground gives the bloodbank more time - just depends on the case.

I presume your patient is not also on coumadin?