What are the recommended protocols for monitoring and supportive care in patients with an intracerebral haemorrhage in a primary care environment?

In a primary care setting, patients with intracerebral haemorrhage (ICH) require urgent referral to secondary care for specialist assessment and management rather than routine monitoring or supportive care within primary care itself. Primary care providers should focus on recognising symptoms suggestive of ICH and ensuring rapid hospital admission. ³

Once admitted, monitoring protocols include frequent neurological observations such as Glasgow Coma Scale (GCS) score, pupil size and reactivity, limb movements, respiratory rate, heart rate, blood pressure, temperature, and oxygen saturation. These observations are typically performed by trained professionals in hospital settings, starting half-hourly until a GCS of 15 is reached, then gradually reducing frequency if stable. Such intensive monitoring is not feasible or recommended in primary care. ¹,³

Supportive care in hospital includes managing blood pressure, preventing complications such as hydrocephalus, and considering surgical interventions if indicated. Primary care’s role post-discharge involves coordinating follow-up care and rehabilitation in line with stroke guidelines. ³

In summary, the recommended protocol in primary care is prompt recognition and urgent referral to hospital for monitoring and supportive care, with no routine monitoring or intervention for ICH patients conducted in primary care. ¹,³