What is your ER's head bleed protocol?

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I work in a small community hospital ED that has been getting a LOT of head bleeds lately, both adult and pediatric. When we get them it gets hectic because we don't work with mannitol, hypertonic saline, or IV antiepileptics often. We're 40 minutes from the nearest trauma center and don't have neuro surg. I want to put together an education packet/protocol that can be pulled out as soon as the CT results confirm a bleed. I want to make a quick reference guide for common pedi and adult meds/dosages. How does your ER deal with head bleeds? Any links/guidance would be helpful.

P.S. here's what I imagine the packet to include at this point:

Mannitol dosing and reconstitution instructions (it's not premixed where I work) as well as rate after bolus

3% saline solution administration guidelines

Common seizure med dosages/infusions (phenobarb, phenytoin, keppra, and benzos)

Atropine dose for bradycardia, select vasopressors to use (i.e. Neosynephrine because it's an alpha agent, though I need to research more)

What else should I include? Is there an algorithm out there? I know there's emphasis on getting them to a trauma center ASAP for an EVD if appropriate and then to the OR, but it still takes time for medflight to arrive and transfer the patient.

Thanks in advance!

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Specializes in NICU, ER, OR.

just do whatever you gotta do to get them to us asap (sorry- i know thats not helpful at all..... but soooo many times we get them too late)

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RNOTODAY - the thing is, by the time Medivac comes to fly them to the trauma center they have usually already herniated. Many of our head bleeds were found down and tubed on scene before coming to the ED....their history is unknown and by the time they've gotten to CT and back they have signs of increased ICP. Short of flying them from their home to a trauma center they're already at a disadvantage by making the stop to a community ER. I want them to have the best shot possible - we all do, which is why I want to know what other hospitals do and what works.

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Our policy is to get them to the OR or the ICU as soon as humanly possible. The ED is NOT the place for these patients!

I'm sorry I can't be more helpful! Maybe you should post your question in the ICU forum.

I'm curious to see more helpful responses.

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Specializes in ER, ICU.

I would start here http://www.strokeassociation.org/STROKEORG/

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Maybe this will help:

http://www.guideline.gov/content.aspx?id=10996

Almost all the way down at the bottom of the page, under the heading "Guideline Availability" is a link to a 116 page PDF file from the Brain Trauma Foundation. Perhaps an algorithm could be developed from this set of guidelines....

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