Immediate care

Careful medical management of the patient with cerebral hemorrhage can be lifesaving and is important even in those who are going to receive surgical treatment. Many patients will be in a coma when found or become unconscious within a few hours. These will need the standard care of the unconscious patient. The priority lies with the preservation of an airway and maintenance of oxygenation. Intubation will be followed by the need for a tracheostomy if coma persists for more than a few days. The patient should be nursed in the 20° to 30° head-up position. The bladder will usually need to be catheterized, and fluid balance is critical with good intravenous access.

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