Ep 195 Management of Subarachnoid Hemorrhage

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 28 May 2024

⏱️ 49 minutes

🔗️ Recording | iTunes | RSS

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Summary

Once the diagnosis of nontraumatic subarachnoid hemorrhage (SAH) has been made, our job is not done. Mortality in SAH patients can be up to 30% even without neurological deficit. Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. In this second part of our 2-part podcast series on subarachnoid hemorrhage with Dr. Katie Lin and Dr. Jeff Perry we answer questions such as: what are the 4 critical priorities in the initial stabilization of the patient with a suspected massive subarachnoid hemorrhage? When is a CT plus CTA of the head indicated up front in the management of patients with suspected subarachnoid hemorrhage? What is the evidence for oral nimodipine in improving outcomes in patients with subarachnoid hemorrhage and how does it work? What can we do in the ED to prevent rebleeding in patients with subarachnoid hemorrhage? What are the simplest and best prognostic tools available for spontaneous subarachnoid hemorrhage to help counsel families and patients? and more...

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases podcast. I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC studios in Toronto.
0:12.7	EM cases is part of SREMI, Schwartz-Risman Emergency Medicine Institute, the nonprofit organization dedicated to improving EM care through research and education.
0:21.4	The opinions expressed on this podcast are intended for information and education purposes only
0:23.5	and should not be used to diagnose, treat, or prevent any medical condition, nor should they be used as a substitute for medical advice and qualified practice and physician.
0:29.0	This episode is brought to you by Easy Recess, the Resuscitation Assistant.
0:33.2	This amazing app has drug dosing, equipment size calculation, treatment algorithms, all in
0:37.8	under three clicks.
0:39.5	Rapid access to life-saving critical info in a user-friendly interface.
0:44.0	Try the app for free with the promo code EMCases or visit easy recess.com slash EMCases.
0:51.8	That's easy recess.com slash EMC-A-S-E-S.
0:57.7	In part one of this two-part podcast series on subarachnoid hemorrhage, we covered when to consider
1:02.4	the diagnosis, why we miss the diagnosis, how to work up subarachnoid hemorrhage, the LP
1:07.8	versus the CTA debate, CSF interpretation, and a lot more. In this part two,
1:13.5	with the help of Dr. Katie Lynn and Dr. Jeff Perry, we'll talk about the sick subarachnoid
1:18.8	hemorrhage patient, a totally different kettle of fish. So to kick it off, so you know what we're
1:24.7	talking about, let's start off with a case.
1:35.9	A 60-year-old female rolls into resuscitation bay with a GCS of 7. She was in the midst of a heated argument with her husband at home when she suddenly developed an abrupt onset of 10 out of 10
1:41.9	headache and vomiting. Vitals include a heart rate of 120, a respiratory
1:48.0	rate of 22, oxygen saturation of 87%, and a blood pressure of 210 on 140. Now, as I mentioned
1:58.8	in part one, while many patients with subracnoid hemorrhage present with a headache alone,
2:03.9	there are others who present much sicker.
2:07.1	And with these patients, all too often, we make the diagnosis of subarachnoid hemorrhage, call neurosurgery, and just stop there.
	...

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