Management of Pontine Hemorrhage

Initial Assessment and Stabilization

The American College of Critical Care recommends immediate clinical assessment using established grading systems to determine the extent of hemorrhage and neurological status (level of consciousness, brainstem reflexes, motor response) 1
The Anaesthesia society recommends securing the airway and providing high FiO2, especially in patients with decreased level of consciousness 2
Establish large-bore IV access (preferably 8-Fr central access) for fluid resuscitation and medication administration, as recommended by the Anaesthesia society 2, 3
Obtain baseline labs including complete blood count, coagulation studies (PT, aPTT, fibrinogen), and cross-match, according to the Anaesthesia society 2
Control blood pressure - target systolic BP of 80-100 mmHg until bleeding is controlled in patients without brain injury, as recommended by the Critical Care society 1

The Anaesthesia society recommends correcting coagulopathy with appropriate blood products 4, 5
For fibrinogen <1 g/L or PT/aPTT >1.5 times normal, administer fresh frozen plasma (15 ml/kg), as recommended by the Anaesthesia society 4
Maintain platelet count above 75 × 10^9/L, according to the Anaesthesia society 5
Consider antifibrinolytic agents in selected cases, as recommended by the Critical Care society 1

The Anaesthesia society recommends admitting patients to a critical care unit for continued monitoring after control of bleeding 2
Implement standard venous thromboprophylaxis once hemostasis is secured, as recommended by the Anaesthesia society 2, 6