When is rapid sequence intubation indicated in acute management of stroke?

Updated: Sep 08, 2017
  • Author: Edward C Jauch, MD, MS, FAHA, FACEP; Chief Editor: Helmi L Lutsep, MD  more...
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Patients presenting with Glasgow Coma Scale scores of 8 or less, rapidly decreasing Glasgow Coma Scale scores, or inadequate airway protection or ventilation require emergent airway control via rapid sequence intubation.

When increased intracranial pressure (ICP) is suspected, rapid sequence induction should be directed at minimizing the potentially adverse effects of intubation.

In unusual cases of potential imminent brain herniation, where the goal of mechanical ventilation is hyperventilation to decrease ICP by decreasing cerebral blood flow, the recommended endpoint is an arterial pCO2 of 32-36 mm Hg. IV mannitol can be considered as well.

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