 Welcome back to intracranial bleed part 5. In this section, we will discuss the management of intracranial bleed. Remember that intracranial bleed can include epidural hematoma, subdural hematoma, subarachnoic hemorrhage, and parenchymal or intracerebral bleed. As with all patients, we start with ABC, who first discuss these three and then we'll go into the specific treatment. First, airway. Patients with intracranial bleed may present with decreased level of consciousness. If the patient is not protecting their airway, or if their GCS is low, we need to intubate the patient. This will be done by rapid sequence induction. The choice of medication should be discussed with your attending physician. Next, breathing. If the patient is hypoxic, oxygen should be supplied. Now we'll go into circulation. In circulation, we will first put the patient on a cardiac monitor. On the monitor, we will measure their heart rate, blood pressure, and O2SAT. All of these are important in a patient with a potential intracranial bleed. If you notice the patient is hypoxic, oxygen should be given like we discussed before. Now let's look at blood pressure management. For patients with intracranial bleed, it is important that we avoid hypotension. Hypotension can increase mortality in patients with intracranial bleed. We avoid hypotension by giving fluids, such as normal saline. Sometimes vasopressors are used to avoid hypotension. There is one caveat in patients with a parenchymal bleed. If the parenchymal bleed is caused by hypotension, we would want to decrease the blood pressure to decrease the hematoma expansion. Different studies suggest different guidelines for the target systolic blood pressure. It is best to discuss it with your attending physician and your consultants. In this group of patients, we still want to avoid hypotension. While the patient is on the cardiac monitor, we want to look out for Cushing's triad. This is a physiological response to increased intracranial pressure. It consists of bratocardia, hypertension, and apnea. Cushing's triad means there is a critical increased intracranial pressure. If it is not fixed, the brain can quickly herniate. Therefore, we need to decrease the intracranial pressure. We will discuss this in the next specific treatment section. After ABC stabilization, we want to think about the specific treatment for our patient. The ultimate treatment for intracranial bleed is mostly surgical. However, there is a subset of patients who do not need surgery for the intracranial bleed. All of them will need supportive treatment. Surgery is needed for epidural, subdural, aneurysmose apereconoid, and bleed in the cerebellum. We need to contact the neurosurgeons promptly for these bleeds. For other bleeds, you may still wish to consult them on a case-by-case basis. Regardless of whether the patient needs surgery or not, they all need supportive treatment. That consists of seizure control, reversing anticoagulants, and decreasing intracranial pressure. We will give benzodiazepines if the patient is seizing. We should also provide analgesia and sedation, particularly if the patient is intubated. If the patient is on anticoagulants, we need to reverse them. That might consist of vitamin K, FFP, or specific clotting factors for the patient. To decrease the intracranial pressure, there are a few temporizing measures. It includes elevating the head of the bed to 30 degrees, giving mannitol or hypertonic saline. However, the definitive management for patients with significantly increased ICP is surgical. In summary, we discussed the management of the patient with intracranial bleed in the emergency department. We would intubate the patient protect their airway, make sure they're not hypoxic by giving oxygen, monitor their heart rate and blood pressure, and avoiding hypotension. We would treat the patient's seizure, reverse the anticoagulants and decrease ICP until the patients have their definitive treatment by surgery. We hope you find this useful. Thank you for watching.