An office based physician is unlikely to require the skills and knowledge in this podcast on intracerebral hemorrhage. However, it is an outstanding review and I’ve included this link and resources.
For office based physicians, likely the recognition of patient with TIA and the determination of the urgency of evaluation is the most important cerebrovascular problem. And for this problem, here are some resources:
After The Diagnosis Of TIA – Determining The Urgency Of The Workup
Posted on August 21, 2017
This podcast, Episode 104 Emergency Management of Intracerebral Hemorrhage – The Golden Hour, Dec. 19, 2017 from Emergency Medicine Cases is awesome. The lecture and show notes just need to be listened to and studied.
[As always these are just my study notes (my peripheral brain) and my reminders to myself — so, Tom, go through the resources again: Listen to the podcast, review the great show notes, and review all the links and resources.]
Here is a summary of the podcast from Dr. Anton Helman who also produced the written summary and blog post:
This is EM Cases Episode 104 – Emergency Management of Intracerebral Hemorrhage – The Golden Hour with Scott Weingart and Walter Himmel. With special guest appearances by Rob Simard and Peter Brindley.
There exists a kind of self-fulfilling prognostic pessimism when it comes to ICH. And this pessimism sometimes leads to less than optimal care in patients who otherwise might have had a reasonably good outcome if they were managed aggressively. Despite the poor prognosis of these patients overall, there is some evidence to suggest that early aggressive medical management may improve outcomes. As such, the skill with which you manage your patient with ICH in those first few hours could be the most important determinant of their outcome. In this Golden Hour you have a chance to prevent hematoma expansion, stabilize intracerebral perfusion and give your patient the best chance of survival with neurologic recovery. In this podcast, the Weingart-Himmel Sessions Redux, we answer questions such as: Should we attempt to manage blood pressure before ICH is confirmed on CT? What are the best drugs to manage blood pressure in ICH? What is the role of POCUS in emergency management of intracerebral hemorrhage? How do we best reverse the effects of anticoagulants and lytics in ICH patients? Are prophylactic antiepileptic drugs ever indicated in ICH in the ED? How do we best risk stratify patients with ICH? What are the indications for neurosurgical intervention? How do we determine if a patient with ICH has elevated ICP and how do we best manage it in the ED? What are the key elements of a neuro-critical care intubation? What is the preferred hyperosmolar agent for elevated ICP? and many more…
An excellent article, which compliments the podcast, is Hemorrhagic Stroke. Updated: Jan 23, 2017 from emedicine.medscape.com.