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

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Scott Weingart

Editor-in-Chief, EMCrit.org at EDECMO LLC

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

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