• Home
  • EMCrit-RACC
  • PulmCrit
  • IBCC
  • EMNerd
  • Tox & Hound
  • About
    • About EMCrit
    • About PulmCrit
    • EMCrit FAQ
    • Subscription Options
  • Contact Us

EMCrit RACC

Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation

  • Airway
  • Archives
You are here: Home / EMCrit-RACC / EMCrit Podcast 8 – Subarachnoid Hemorrhage

EMCrit Podcast 8 – Subarachnoid Hemorrhage

August 16, 2009 by Scott Weingart 4 Comments

This week's podcast is on the management of a the patient with SAH. It's not a complete review, just some tips and reminders.

Best article for EM that I've found, comes out of Columbia

For more reviews on mostly ICU issues see here and here.

Update: Critical Care Management of Patients Following Aneurysmal SAH Guidelines from NCC

1. Get a neuro exam before you intubate

2. Intubation

Give pretreatment, now just lidocaine and fentanyl

Etomidate or propofol; plus sux.

Most experienced intubater should perform laryngoscopy

3. Treat Pain

and if intubated, give sedation

4. Treat Vasospasm

give nimodipine 60 mg PO or NGT

5. BP Control

place a-line

treat pain first

Give Labetalol or Nicardipine to achieve the patient's baseline BP if the patient has good mental status

if they are obtunded, be a bit more conservative until ICP monitoring is in place

If MAP is below 80, give fluids, pressors, and inotropes

6. Anti-seizure prophylaxis

Load with phenytoin or fosphenytoin

7. Anti-fibrinolytics

Amicar is the main one these days; ask your neurosurgeon/neurointensivist on a case-by-case basis

see ehced.org for drip sheets

8. Reverse Coagulopathy

9. Think Heart

these patients can get EKG changes, dysrhythmias, LV stunning, and frank infarcts from their SAH

10. ICP ASAP

get the neurosurgeons to get the EVD (external ventricular drain) aka IVC (intraventricular catheter) in place as soon as possible

keep ICP < 20 and CPP > 55-60

Please Subscribe and Please Comment!

.

http://media.blubrry.com/emcrit/p/traffic.libsyn.com/emcrit/EMCrit-Podcast-20090816-8-SAH.mp3

Podcast: Play in new window | Download (Duration: 15:35 — 10.7MB) | Embed

Subscribe: Apple Podcasts | Android | Google Podcasts | RSS | More

  • Author
  • Recent Posts

Scott Weingart

An ED Intensivist from NY. No conflicts of interest (coi).

Latest posts by Scott Weingart (see all)

  • EMCrit 261 – Thrombolysis during Cardiac Arrest - December 12, 2019
  • EMCrit 260 – Thoughts on the NEJM Acute Upper Airway Obstruction Review - November 30, 2019
  • EMCrit 259 – Cardiogenic Shock — The Next Level & Mechanical Circulatory Support with Jenelle Badulak - November 13, 2019

Share this:

  • Facebook
  • Twitter
  • Reddit
  • Pinterest
  • Email
  • Print

Filed Under: EMCrit-RACC Tagged With: amicar, archive podcasts, hyperventilation, ICP, intracranial bleed, neurology, old, podcasts, SAH, subarachnoid hemorrhage

Cite this post as:

Scott Weingart. EMCrit Podcast 8 – Subarachnoid Hemorrhage. EMCrit Blog. Published on August 16, 2009. Accessed on December 14th 2019. Available at [https://emcrit.org/emcrit/sah/ ].

Financial Disclosures

Unless otherwise noted at the top of the post, the speaker(s) and related parties have no relevant financial disclosures.

You finished the 'cast,
Now get CME credit

Already an EMCrit CME Subscriber?
Click Here to Get CME Credit for the Episode


Not a subcriber yet? Why the heck not?
By subscribing, you can...

  • Get CME hours
  • Support the show
  • Write it off on your taxes or get reimbursed by your department

Sign Up Today!


.

Subscribe Now

If you enjoyed this post, you will almost certainly enjoy our others. Subscribe to our email list to keep informed on all of the Resuscitation and Critical Care goodness.

This Post was by the EMCrit Crew, published 10 years ago. We never spam; we hate spammers! Spammers probably work for the Joint Commission.

4
Comment Here

avatar
We may delete without a full, true name
Your Job (i.e. intensivist, CCRN, etc.)
3 Comment threads
1 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
4 Comment authors
don zweigJohn Paige IIIemcritDr.Falah Hafuth Recent comment authors
avatar
We may delete without a full, true name
Your Job (i.e. intensivist, CCRN, etc.)
newest oldest most voted
Dr.Falah Hafuth
Guest
Dr.Falah Hafuth

very good refreshing talk , well done
Would you intubat the patien if the GCS more than 10 , but the transfer time (by EMS) take 2 hours?
Thank you

Vote Up0Vote Down  Reply
10 years ago
Scott Weingart
Author
Scott Weingart

great question. I would intubate this patient but the key is to sedate them with propofol for the transport so that the receiving hospital can extubate on arrival if the mental status is still good.

Vote Up0Vote Down  Reply
10 years ago
John Paige III
Guest
John Paige III

Would you intubate a patient with a GCS of 15 with a normal neurological status and transfer 15 minutes away?

I ran into this problem on shift the other night and did not to preserve the neurological exam for the neurosurgeons, I don’t know if it is the right or wrong move.

Thanks,

JP3

Vote Up0Vote Down  Reply
5 years ago
don zweig
Guest
don zweig

is the article you recommend still the best one? or is there a new update? do you intubate all severe bleeds even if awake and following commands if they are to be transferred?

Vote Up0Vote Down  Reply
2 years ago

Follow EMCrit Everywhere

Click for More Subscribe Options


Other Stuff

  • Have a great idea for the next podcast? Share it here!
  • Tough Questions. Maybe you have an answer!
  • When you're done listening to the podcast,
    check out these great sites.

Who We Are

We are the EMCrit Project, a team of independent medical bloggers and podcasters joined together by our common love of cutting-edge care, iconoclastic ramblings, and FOAM.

Like Us on Facebook

Like Us on Facebook

Subscribe by Email

EMCrit is a trademark of Metasin LLC. Copyright 2009-. This site represents our opinions only. See our full disclaimer, our privacy policy, commenting policy and here for credits and attribution.

wpDiscuz
loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
You are going to send email to

Move Comment