Physiologic derangements, such as hypoxemia, metabolic acidosis, hyperglycemia, BP instability, and fever, can worsen brain injury and has been independently associated with increased M&M, but no studies showing benefit of corrections.
Maintain MAP>80 (CPP of 60 as long as ICP<20)
Give IVF
Give pressors if IVF ineffective
AHA/ASA has no formal recommendations but states that decreasing to SBP <160 is reasonable
Rapid SBP lowering <140 has been advocated with early research showing improved functional outcome, but more recent work has found no difference between SBP <140 and <180
Ensure appropriate pain control and sedation before adding antihypertensives
Coumadin → (Prothrombin complex concentrate (Kcentra) or FFP) + vitamin K
Aspirin → DDAVP
Plavix → Platelets
Dabigatran (Pradaxa) → Idarucizumab (Praxbind): 5 grams IV
Only CCB studied that has been shown improve outcomes (contrary to popular belief, it does not affect large-vessel vasospasm but does decrease incidence of delayed cerebral ischemia)
Give 60mg q4hr PO or NGT only (never IV) within 96hr of symptom onset. NNT 13 to prevent one poor outcome
Keep an eye on BP for fluctuations
Controversial; prevents vasospasm acting as NMDA antagonist and a calcium channel blocker; maintain between 2-2.5 mmol/L
Controversial; 3 day course may be preferable
Phenytoin, levetiracetam, carbamazepine and phenobarb. Phenytoin can be associated with worse neurologic & cognitive outcome[citation needed]
Controversial; evidence suggests is neither beneficial nor harmful
Controversial; consider sliding scale if long patient stay in ED while awaiting ICU bed
Surgical clipping and endovascular coiling are definitive treatment
Antifibrinolytic - Controversial; if delayed aneurysmal treatment, consider short term therapy (<72 hrs) with TXA or aminocaproic acid
Consider neuroprotective intubation
3 minutes before intubation
Lidocaine 1-2mg/kg to blunt sharp MAP increase
Fentanyl 2-5mcg/kg as sympatholytic
Sedation
Etomidate if blood pressure normal
Propofol if blood pressure high
Succinylcholine without defasciculating dose
Ensure patient is pain-free for post-intubation sedation
Propofol with fentanyl
Try to prioritize pain control with fentanyl
3 minutes before intubation
Lidocaine 1-2mg/kg to blunt sharp MAP increase
Fentanyl 2-5mcg/kg as sympatholytic
Sedation
Etomidate if blood pressure normal
Propofol if blood pressure high
Succinylcholine without defasciculating dose
Lidocaine 1-2mg/kg to blunt sharp MAP increase
Fentanyl 2-5mcg/kg as sympatholytic
Etomidate if blood pressure normal
Propofol if blood pressure high
Propofol with fentanyl
Try to prioritize pain control with fentanyl
Subarachnoid hemorrhage
Intra-axial
Subdural hemorrhage
Hemorrhagic stroke 
Ischemic stroke
Traumatic intracerebral hemorrhage
Hemorrhagic stroke
Extra-axial