We know that hypotension and malperfusion, especially in the first 24 hours, is incredibly harmful. Don’t just leave the patient hypotensive for 15-20 minutes while giving them fluids. Start norepinephrine or push-dose pressors immediately.Patients may develop cardiogenic shock or Takotsubo cardiomyopathy from the brain injury. This has been reported in other types of bleeds. Hypotension may sometimes be seen in aneurysmal subarachnoid hemorrhages due to the neurocardiogenic axis effects.Did the patient get a lot of sedation for intubation? This can cause hypotension.You need to match the patient’s urine output to avoid hypotension.
People often administer mannitol without realizing that it is a potent diuretic. Hypotension from brain swelling does not usually occur until the point of herniation.You should be concerned about hypotension. Often you are dealing with intractable hypertension. Usually the brain and neurovascular system are trying hard to increase perfusion to the brain. Why is the patient hypotensive? The patient should be hypertensive.A patient has isolated head trauma with hemorrhage.▪ Propofol is a good option for sedation due to neuroprotective effects and despite associated hypotension, which may be managed with pressor support. ▪ Start norepinephrine or push-dose pressors immediately if there is hypotension. ▪ Mannitol is a potent diuretic and fluid replacement should match urine output. We have 25 Whiskeytown Music torrents for you!Ĭritical Care Mailbag - Isolated Head Trauma Rob Orman MD and Scott Weingart MD Take Home Points ▪ Hypotension in a patient with isolated head trauma is worrisome.
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