Induction - If emergent, treat this patient as a full stomach, use RSI technique with cricoid pressure on induction. For standard/planned cases where a bleed is chronic, use a standard GETT induction. Arterial Line - Not common, unless the patient is deteriorating. Very Short Duration - For this reason, hyperventilation is not usually necessary unless there is a traumatic brain injury and neuro protection is needed. Prevent BP swings - Have labetalol, lopressor, neosynepherine, and ephedrine available. Emergence - Deep extubation is preferred. Place HOB up to at least 30 degrees. Prevent coughing as much as possible.
Burr Hole procedure is necessary when a patient has cranial bleeding due to trauma or stroke that requires immediate intervention to decrease the pressure on the brain. This procedure can be emergent or urgent, depending on the injury, acute vs chronic. The surgeon will make a small incision on the scalp over the affected region of the bleed, then drill a small burr hole through the skull to the dura. For a subdural hematoma the surgeon will then cut through the dura, exposing the hematoma to be washed out or suctioned.
