Initial Management of Patient with High-Grade Encephalopathy - Flowchart

Initial Management of Patient with High-Grade Encephalopathy - Flowchart

Initial Management of Patient with High-Grade Encephalopathy - Flowchart Hepatic Encephalopathy Hepatic Encephalopathy

«Flowchart»

Acute or hyperacute liver failure

Acute or hyperacute liver failure

Acute or hyperacute liver failure

Grade II or greater encephalopathy

Grade II or greater encephalopathy

Grade II or greater encephalopathy

Evidence of severe liver failure in referring hospital

Evidence of severe liver failure in referring hospital

Evidence of severe liver failure in referring hospital

Intubated for transfer

Intubated for transfer

Intubated for transfer

Intubate and ventilate

Intubate and ventilate

Intubate and ventilate

Standard of care

Standard of care

Standard of care

Minimal tactile stimulation
Head up 30 degrees
Maintain normocapnia
Induce hypernatremia (150 mmol/L)
Prevent hyperthermia
Prevent fluid overload–consider CVVH

Minimal tactile stimulation
Head up 30 degrees
Maintain normocapnia
Induce hypernatremia (150 mmol/L)
Prevent hyperthermia
Prevent fluid overload–consider CVVH

Minimal tactile stimulation
Head up 30 degrees
Maintain normocapnia
Induce hypernatremia (150 mmol/L)
Prevent hyperthermia
Prevent fluid overload–consider CVVH

Insert a reverse jugular line

Insert a reverse jugular line

Insert a reverse jugular line

Are they at risk of ICH?

Are they at risk of ICH?

Are they at risk of ICH?

Consider ICP bolt

Consider ICP bolt

Consider ICP bolt

End

End

End

CVVH, continuous venovenous hemofiltration; ICH, intracranial hypertension; ICP, intracranial pressure.

CVVH, continuous venovenous hemofiltration; ICH, intracranial hypertension; ICP, intracranial pressure.

CVVH, continuous venovenous hemofiltration; ICH, intracranial hypertension; ICP, intracranial pressure.

CVVH ICH ICP