**1.2 Management of intracerebral hemorrhage in the HHHA**

ICH is the fourth most frequent reason for neurological consultation in the emergency room (ER) of the Hospital Dr. Hernán Henríquez Aravena (HHHA) in Temuco, Chile, accounting for 4.5–7% of the care provided by the neurologist and 13.5–18.1% of stroke cases [28, 29].

The HHHA is located in the heart of the Temuco-PLC conurbation (360,000 inhabitants), about 670 kilometers south of Santiago de Chile. The HHHA has 730 beds, is the only hospital of high complexity in the Araucanía Region, and serves a beneficiary population of approximately 800,000 inhabitants [30]. The Araucanía Sur Health Service also has four medium-complexity hospitals (nodes) and eight low-complexity hospitals. The HHHA is also a referral center for neurological emergencies from the Araucanía Norte Health Service.

The HHHA neurology unit does not have its own service and depends on the internal medicine service. Our hospital lacks a stroke unit [30]. The hospital has two CT scanners and a MRI. There is an interventional neuroradiologist (MP) during daytime hours.

The HHHA has face-to-face neurologists 24/7 in the ER since July 2013 [29]. Patients with mild ICH (ICH score 0–1) are admitted to the internal medicine service [31]. Patients with severe ICH (ICH score 2–3) are admitted to the ICU. The ICU has 54 beds (18 with mechanical ventilation) for a population of about 800,000 inhabitants. Most patients with ICH stay a long time (24–48 h) in the ER waiting for a bed in the ICU. In these conditions it is very difficult to provide the standard care to these patients, including intensive blood pressure management and general neuroprotection. Based on the results of INTERACT2 and ATACH-2 studies, our target for systolic blood pressure in the first 48 h is less than 140 mmHg [32, 33]. Intravenous labetalol and nitroglycerin are the drugs more frequently used.

Another issue is the delay for the presentation of ICH patients. In a recent study, we estimated a median of 4 h and 45 mins (P25–P75 = 3 h 13′–14 h 16′) for arrival to the ER. Just 17.4% of patients with ICH arrived in less than 3 h. In a chi-square test, the variables associated with a presentation in under 3 h were living in Temuco-PLC (p < 0.01), urban origin (p = 0.02), arrival by own car (p = 0.032), and severity (NIHSS ≥7) (p < 0.01). In a logistic regression model, only living in Temuco-PLC and severity were statistically significant with a combined odds ratio of 5.97 (95% CI = 3.23–11.04) [34].

The objective of this chapter is to report the experience in the treatment of patients with ICH in a regional public hospital in Temuco, Chile.
