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Subarachnoid Hemorrhage 02

Topic: Adult

Created on Wednesday, November 28 2007 by jdmiles

Last modified on Wednesday, November 28 2007.


Courtesy of Wikimedia Commons

A 60 year old female is found down and brought by paramedics to the emergency departement. GCS is 6, and the patient is intubated for airway protection. The patient withdraws all extremities to painful stimuli. A stat head CT reveals the above abnormalities.

An angiogram is performed, and the source of the bleeding is found and secured. The patient is admitted to the neurological intensive care unit.

At this stage, an essential aspect of this patient's management now consists of which of the following?


 
        A) Maintain hypervolemia and low central venous pressure
 
        B) Maintain hypervolemia and supranormal central venous pressure
 
        C) Maintain hypovolemia and supranormal central venous pressure
 
        D) Maintain euvolemia and low central venous pressure
 
        E) Maintain hypervolemia and normal central venous pressure
 

 


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This question was created on November 28, 2007 by jdmiles.
This question was last modified on November 28, 2007.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) Maintain hypervolemia and low central venous pressure

This answer is incorrect.


This patient has suffered a subarachnoid hemorrhage. If a patient survives the initial event, the two most feared complications are rebleeding and vasospasm. In this patient, the risk of rebleed has been reduced by intravascular coiling of the causative aneurysm. The patient remains at risk for vasospasm, which can result in infarction and death. As a preventive measure, the patient should be maintained hypervolemic, with an elevated CVP.  (See References)

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B) Maintain hypervolemia and supranormal central venous pressure

This answer is correct.


This patient has suffered a subarachnoid hemorrhage. If a patient survives the initial event, the two most feared complications are rebleeding and vasospasm. In this patient, the risk of rebleed has been reduced by intravascular coiling of the causative aneurysm. The patient remains at risk for vasospasm, which can result in infarction and death. As a preventive measure, the patient should be maintained hypervolemic, with an elevated CVP.  (See References)

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C) Maintain hypovolemia and supranormal central venous pressure

This answer is incorrect.


This patient has suffered a subarachnoid hemorrhage. If a patient survives the initial event, the two most feared complications are rebleeding and vasospasm. In this patient, the risk of rebleed has been reduced by intravascular coiling of the causative aneurysm. The patient remains at risk for vasospasm, which can result in infarction and death. As a preventive measure, the patient should be maintained hypervolemic, with an elevated CVP.  (See References)

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D) Maintain euvolemia and low central venous pressure

This answer is incorrect.


This patient has suffered a subarachnoid hemorrhage. If a patient survives the initial event, the two most feared complications are rebleeding and vasospasm. In this patient, the risk of rebleed has been reduced by intravascular coiling of the causative aneurysm. The patient remains at risk for vasospasm, which can result in infarction and death. As a preventive measure, the patient should be maintained hypervolemic, with an elevated CVP.  (See References)

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E) Maintain hypervolemia and normal central venous pressure

This answer is incorrect.


This patient has suffered a subarachnoid hemorrhage. If a patient survives the initial event, the two most feared complications are rebleeding and vasospasm. In this patient, the risk of rebleed has been reduced by intravascular coiling of the causative aneurysm. The patient remains at risk for vasospasm, which can result in infarction and death. As a preventive measure, the patient should be maintained hypervolemic, with an elevated CVP.  (See References)

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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973) Advertising:
2. Rowland, L.P. (Ed) (2000). Merritt's Neurology, 10th Edition. Lippincott Williams & Wilkins, Philadelphia. (ISBN:0683304747) Advertising:
3. Bradley, W.G., Daroff, R.B., Fenichel, G.M., and Jankovic, J.(Eds.) (2004). Neurology in Clinical Practice, Fourth Edition. Butterworth Heinemann, Philadelphia. (ISBN:0750674695) Advertising:
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adult
Subarachnoid Hemorrhage 02
Question ID: 112807160
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 11/28/2007
Modified: 11/28/2007
Estimated Permutations: 8400

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