A 25-year-old is admitted with loss of consciousness after cocaine over-dosage. On examination BP= 200/100 with GCS of 7/15. The right-sided pupil is dilated and shows a sluggish reaction to light. Which is not recommended for this patient?
CNS bleed due to a cocaine overdose. The dilated right side pupil indicates evidence of uncal herniation. Sodium nitroprusside is not recommended to manage a hypeensive crisis in CNS event. The metabolism of sodium nitroprusside, which occurs in the red blood cell, liberates cyanide that can accumulate in those receiving high doses or prolonged infusions. The current guidelines recommend the use of nicardipine or labetalol. Mannitol or 3% saline can be used to lower raised ICP. Neuromuscular paralysis is useful to reduce ICP.Airway compromise is always present in GCS less than 8. Hence NM paralysis and intubation is to be done.
Administer mannitol at 1g/kg body weight
Administer hypeonic fluids to maintain sodium of 145mEq/dl
Initiate sodium nitroprusside to achieve MAP below 130 mmHg
Neuromuscular paralysis
Brain Hemorrhage