Treatment of Hemorrhagic Stroke
emergency room, treatment, stroke, first-aid, ICU, ward
Stroke basically happened in our body due to blockage or rupture of the blood vessel in the brain, with different causes due to fatty deposits in within the arteries, hypertension, blood-thinning medications and aneurysm with risk factors such as age and race, wherein everyone is at risk with stroke if we do not care for our body.
During my mother's attack last March 24, 2016, I rushed her to the nearest hospital in which upon entering the emergency room, the nurses and the resident physician on deck gave the following treatments after assessment:
2. Insertion of Intravenous Fluid: Plain NSS
3. Insertion of side drip of Mannitol
4. Metoclopromide thru IV push (since my mother vomited several times)
5. Insertion of Foley Catheter
6. Imaging and Diagnostic procedure such as CBC, Urinalysis, RBS, Lipid Profile , CT Scan, Chest x-ray
Basically the treatment and the management of patients with hemorrhagic stroke is to control the bleeding, the seizure and of course the Blood pressure and the intracranial pressure. These are the critical areas we need to immediately stabilize. Wherein, upon arrival my mother's blood pressure was 190/150, upon giving Mannitol, my mother's blood pressure lowered to 140/100 but severe vomiting was happening so the physician ordered Metoclopromide to stop the vomiting, the vomiting was not relieved by the Metoclopromide and my mother still have a persistent vomiting and was then transferred in ICU because the Ct Scan indicated a CVA bleed that my mother needs continues observation and monitoring.
Upon arrival at the ICU, the nurses told us to get the certain medications in the pharmacy.
Those medications are as follows: Dexamethasone (a corticosteroid, to reduce brain inflammation), Losartan (angiotensin II receptor antagonists, to lower the blood pressure by keeping blood vessels from narrowing and improves blood flow), Citicoline (CNS Stimulant or a Nootropics, to increase the blood flow and oxygen consumption of the brain), Metoclopromide (prokinetic agent to decrease symptoms of vomiting), and omeprazole (proton pump inhibitors, to block or decrease the production of acid by the stomach).
Another contraption inserted to my mother, is a nasogastric tube (a tube inserted through the nose to throat to stomach) since my mother's gag reflex was altered and she cannot take the losartan tablet orally and due to severe vomiting, my mother cannot take anything through mouth, so to prevent aspiration and other complication,placement of NGT was ordered.
My mother's consciousness was altered but she never loss her consciousness.She respond to her treatments well but her condition slightly deteriorate when she was in the ICU since she felt alone there, the viewing time is only 1 hour during morning and 1 hour during afternoon, wherein she felt she's sick and fighting alone but still her condition gets well and was able to transfer to ward after 3 days of being confined in the ICU.
The treatment in the ward was aggressive and really fast, that every improvement will lead to decreasing of the dose or shifting of medication from IV medication to oral medication. The physician's approach was step by step that the physician carefully monitored my mother's condition before shifting or decreasing the dose of medication. He also consider the persistent headache that my mother is experiencing during that time, so decreasing the dose of dexamethasone and mannitol should be carefully observed. He was so careful with the treatment to condition my mother's body and be prepared for discharge. During the confinement in the ward, same medication in the ICU was administered except for citicoline, according to the attending physician, his goal was to stabilize first the clot and the inflammation of the brain, so the medication was purely mannitol and dexamethasone with omperazole and senokot to soften the stool and avoid straining that can lead to ballooning of the blood vessel.
Day by day the condition of my mother progress, such as removal of foley catheter, removal of NGT, from eating from NGT to diet as tolerated, to large doses of intravenous dexamethasone to oral dexamethasone, removal of mannitol and intravenous fluid and after 10 days of being hospitalized, my mother was discharged with left sided body weakness, slight facial asymmetry, and sensitivity to light that she felt more relaxed with closed eyes than opening her eyes.