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(II) Treatment of acute cerebral hemorrhage in patients with hemodialysis
This is a mind map on the treatment of acute cerebral hemorrhage in patients with hemodialysis. The main contents include: 1. The clinical manifestations of acute cerebral hemorrhage during dialysis should be stopped immediately and the infusion of anticoagulant should be quickly removed from the machine. , 2. Patients with hemodialysis who diagnose acute cerebral hemorrhage are recommended to transfer to the stroke unit or neurology monitoring room for treatment. The patient's respiratory, oxygen inhalation, temperature control and blood sugar control are the same as those of non-dialysis patients.
Edited at 2025-02-28 22:50:15- Rumi 10 spiritual high-dimensional awakenings
Rumi: 10 dimensions of spiritual awakening. When you stop looking for yourself, you will find the entire universe because what you are looking for is also looking for you. Anything you do persevere every day can open a door to the depths of your spirit. In silence, I slipped into the secret realm, and I enjoyed everything to observe the magic around me, and didn't make any noise. Why do you like to crawl when you are born with wings? The soul has its own ears and can hear things that the mind cannot understand. Seek inward for the answer to everything, everything in the universe is in you. Lovers do not end up meeting somewhere, and there is no parting in this world. A wound is where light enters your heart.
- Pathophysiology - Heart failure
Chronic heart failure is not just a problem of the speed of heart rate! It is caused by the decrease in myocardial contraction and diastolic function, which leads to insufficient cardiac output, which in turn causes congestion in the pulmonary circulation and congestion in the systemic circulation. From causes, inducement to compensation mechanisms, the pathophysiological processes of heart failure are complex and diverse. By controlling edema, reducing the heart's front and afterload, improving cardiac comfort function, and preventing and treating basic causes, we can effectively respond to this challenge. Only by understanding the mechanisms and clinical manifestations of heart failure and mastering prevention and treatment strategies can we better protect heart health.
- Pathophysiology - ischemia - reperfusion injury
Ischemia-reperfusion injury is a phenomenon that cellular function and metabolic disorders and structural damage will worsen after organs or tissues restore blood supply. Its main mechanisms include increased free radical generation, calcium overload, and the role of microvascular and leukocytes. The heart and brain are common damaged organs, manifested as changes in myocardial metabolism and ultrastructural changes, decreased cardiac function, etc. Prevention and control measures include removing free radicals, reducing calcium overload, improving metabolism and controlling reperfusion conditions, such as low sodium, low temperature, low pressure, etc. Understanding these mechanisms can help develop effective treatment options and alleviate ischemic injury.
(II) Treatment of acute cerebral hemorrhage in patients with hemodialysis
- Rumi 10 spiritual high-dimensional awakenings
Rumi: 10 dimensions of spiritual awakening. When you stop looking for yourself, you will find the entire universe because what you are looking for is also looking for you. Anything you do persevere every day can open a door to the depths of your spirit. In silence, I slipped into the secret realm, and I enjoyed everything to observe the magic around me, and didn't make any noise. Why do you like to crawl when you are born with wings? The soul has its own ears and can hear things that the mind cannot understand. Seek inward for the answer to everything, everything in the universe is in you. Lovers do not end up meeting somewhere, and there is no parting in this world. A wound is where light enters your heart.
- Pathophysiology - Heart failure
Chronic heart failure is not just a problem of the speed of heart rate! It is caused by the decrease in myocardial contraction and diastolic function, which leads to insufficient cardiac output, which in turn causes congestion in the pulmonary circulation and congestion in the systemic circulation. From causes, inducement to compensation mechanisms, the pathophysiological processes of heart failure are complex and diverse. By controlling edema, reducing the heart's front and afterload, improving cardiac comfort function, and preventing and treating basic causes, we can effectively respond to this challenge. Only by understanding the mechanisms and clinical manifestations of heart failure and mastering prevention and treatment strategies can we better protect heart health.
- Pathophysiology - ischemia - reperfusion injury
Ischemia-reperfusion injury is a phenomenon that cellular function and metabolic disorders and structural damage will worsen after organs or tissues restore blood supply. Its main mechanisms include increased free radical generation, calcium overload, and the role of microvascular and leukocytes. The heart and brain are common damaged organs, manifested as changes in myocardial metabolism and ultrastructural changes, decreased cardiac function, etc. Prevention and control measures include removing free radicals, reducing calcium overload, improving metabolism and controlling reperfusion conditions, such as low sodium, low temperature, low pressure, etc. Understanding these mechanisms can help develop effective treatment options and alleviate ischemic injury.
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(II) Treatment of acute cerebral hemorrhage in patients with hemodialysis
1. If the clinical manifestations of acute cerebral hemorrhage occur during dialysis, the anticoagulant infusion should be stopped immediately and the machine should be removed quickly.
2. For hemodialysis patients who diagnose acute cerebral hemorrhage, it is recommended to transfer to the stroke unit or neurology monitoring room for treatment. The patient's respiratory, oxygen inhalation, temperature control and blood sugar control are the same as those of non-dialysis patients.
3. Patients with large cerebral hemorrhage accompanied by cerebral edema, elevated intracranial pressure (predicted bleeding volume > 30 ml) or ventricular hemorrhage should evaluate the indications for surgical emergency surgery, and the surgical indications are those of non-dialysis patients.
4. Intracranial hypertension treatment for patients with acute cerebral hemorrhage caused by hemodialysis is recommended for intravenous injection of glycerol fructose. However, after injecting glycerol fructose intravenously, water cannot be eliminated from the urine, which can increase circulating blood volume; therefore, it is recommended to use glycerol fructose during dialysis.
5. It is recommended to actively control blood pressure from the acute phase
(1) Patients with systolic blood pressure >180mmHg or average arterial pressure >130mmHg, it is recommended that the previous value of blood pressure 80% is used as the target of lowering blood pressure, and slowly lowering blood pressure; systolic blood pressure <140mmHg helps prevent the hematoma from expanding. Antihypertensive drugs are selected for nicardipine, diltiazepine hydrochloride, nitroglycerin and sodium nitroprusside intravenous infusion.
(2) To prevent recurrence of cerebral hemorrhage, it is recommended to control diastolic pressure <90mmHg.
(3) Prevent the occurrence of cerebral hemorrhage and control blood pressure <140/90mmHg is beneficial.
6. The incidence of microcerebellar hemorrhage in patients with long-term hypertension or previous cerebrovascular diseases is 19% to 35%. SWI examination is recommended for this type of patients, and CT angiography, MRI contrast-free angiography, and digital subtraction angiography are performed when necessary to detect potential vascular lesions such as intracranial arteriovenous malformations and hemangiomas.
7. Hemodialysis treatment for acute cerebral hemorrhage in patients with hemodialysis
(1) Avoid hemodialysis within 24 hours of acute cerebral hemorrhage.
(2) Select dialysis methods that affect less intracranial pressure in the early stage of onset: ① Continuous hemodialysis filtration; ② Peritoneal dialysis; ③ Daily inefficient and slow hemodialysis.
(3) Glycerol fructose is given intravenous injection during dialysis, combined with ultrafiltration treatment to reduce intracranial pressure.
(4) Citrate can be used for local anticoagulant. Warfarin is discontinued and vitamin K is given; protamine antagonism is given in patients who use warfarin or low molecular weight heparin.