Head bleed

[name?]

Curious as to when you guys intubate your ICH patients. Had one last night with a sizable bleed, neurosurg asked to wait to follow the exam. Neuro admitted and ask that we intubate early. I've been prone to intubating once we verify bleed with any e/o shift/ventric extension even if the patient is intact because of the risk of rapid deterioration. Thoughts?

Thanks

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[docB]

I would do it early, ie. hopefully before they aspirate and definitely before they leave the ED.

As for following the exam I use roc and etomidate and then diprivan. The roc paralyzes them for 30-40 minutes so you lose that time frame but then the diprivan can be turned off and they get their exam back quickly.