The Recs:
- Use Hunt & Hess or WFN Scores
- Risk of early rebleeding is high – be quick and decisive in getting the aneurysm secured
- Still recommending LP if negative CT
- Get CTA if CT or LP is positive
- MRI may be useful if negative CT, but if negative you still need a LP
- Keep SBP < 160 until clip/coil
- If delay until clip/coil, use aminocaproic acid or TXA
- Give nimodipine to prevent delayed cerebral ischemia
- Need CSF drainage if acute, symptomatic hydrocephalus
- Consider anti-convulsants in acute SAH management
- Use isotonic fluids, keep fluid balance positive
- Keep patient Normothermic
- Control Hyperglycemia
from:
Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage
doi: 10.1161/?STR.0b013e3182587839
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An insanely good aged sour ale: Rodenbach 2009 Vintage
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Excelent and practical synthesis of a large document
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