Episode 4 – Subarachnoid Hemorrhage Guidelines

The Recs:

1. Use Hunt & Hess or WFN Scores
2. Risk of early rebleeding is high – be quick and decisive in getting the aneurysm secured
3. Still recommending LP if negative CT
4. Get CTA if CT or LP is positive
5. MRI may be useful if negative CT, but if negative you still need a LP
6. Keep SBP < 160 until clip/coil
7. If delay until clip/coil, use aminocaproic acid or TXA
8. Give nimodipine to prevent delayed cerebral ischemia
9. Need CSF drainage if acute, symptomatic hydrocephalus
10. Consider anti-convulsants in acute SAH management
11. Use isotonic fluids, keep fluid balance positive
12. Keep patient Normothermic
13. Control Hyperglycemia

from:
Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage
doi: 10.1161/?STR.0b013e3182587839

What is EMCrit drinking?

An insanely good aged sour ale: Rodenbach 2009 Vintage

Podcast: Play in new window | Download (Duration: 10:15 — 9.5MB) | Embed

Subscribe: Apple Podcasts | Android | Google Podcasts | Spotify | 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 Podcast 263 – The Venous Side – Part 1 – VEXUS Score with Phillipe Rola - January 14, 2020
• EMCrit 262 – Midlines – Part 1 - December 27, 2019
• EMCrit 261 – Thrombolysis during Cardiac Arrest - December 12, 2019