Dr. Setyo Widi ICU ICH1

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Text of Dr. Setyo Widi ICU ICH1

CURRENT CRITICAL MANAGEMENT OF CURRENT CRITICAL MANAGEMENT OF SPONTANEOUS INTRACEREBRAL SPONTANEOUS INTRACEREBRAL HAEMORRHAGEHAEMORRHAGE (SICH)(SICH)Setyo Widi NugrohoSetyo Widi NugrohoDepartment of Neurosurgery Department of NeurosurgeryPadjadjaran University/Hasan Sadikin HospitalPadjadjaran University/Hasan Sadikin Hospital Bandung Bandung IntrodutionIntrodution!Spontaneous intraere"ral hemorrhage #SI$H% isa"lood lot that arises in the "rainparenhyma inthea"seneof trauma or surgery !&his entity aounts for '( to ')* of all strokes !Higher mortality rate than either ishemi stroke or su"arahnoid hemorrhage !+""rupt elevation of "lood pressure rupture of small penetrating arteries Pathology , -oationPathology , -oation .tiology.tiology!$ommon auses /0hypertension0amyloidangiopathy0oagulopathy0vasular anomalies0tumors1 and 0various drugs Diagnosti ProedureDiagnosti Proedure!Physial diagnosti +"rupt onset of onsiousness and neurologi defiits!2adiodiagnosti / 0$& sanning /! Initial diagnosti modality of hoie in SI$H0+ngiography ! should "e onsidered in all ases e3ept those involving older patients 4ith pree3isting hypertension in thalami1 putaminal1 or ere"ellar hemorrhage 052I1 52+ $2I&I$+- 5+N+6.5.N&$2I&I$+- 5+N+6.5.N&!Initial 5anagement /0Identify site of haemorrhage 4ithin neura3is!$linial e3am!2adiodiagnosti / $& San 152I1 52+1 DS+0Prevent su"se7uent damage from re"leeding edema1 or hypo3ia8 Initial stepsInitial steps!+ir4ay, Breathing ontrol06$S 9 : Intu"ation0P$;< / luid 5anagement /! Intavenous solution # euvolume1 slight hyperosmolar%! 5anitol