Assessment & Plan (short)
#Subarachnoid hemorrhage (SAH)
Patient presents with sudden onset thunderclap headache and meningismus concerning for subarachnoid hemorrhage. If SAH noted on NCHCT, proceed to CTA to determine etiology. If SAH not found on NCHCT (98% sensitive within first 12 hr, then 50% after 7 days) but strong suspicion, perform LP.
- NeuroICU admission, NSGY eval
- NIHSS score ***, GCS ***
- ICU for q1h neuro checks
- Goal SBP <160, if aneurysmal SBP <140 (All should receive Nimodipine)
Assessment & Plan (long)
#Subarachnoid hemorrhage (SAH)
Patient presents with sudden onset thunderclap headache and meningismus concerning for subarachnoid hemorrhage. If SAH noted on NCHCT, proceed to CTA to determine etiology. If SAH not found on NCHCT (98% sensitive within first 12 hr, then 50% after 7 days) but strong suspicion, perform LP. Symptomatic aneurysmal SAH should be treated surgically/endovascularly. Asymptomatic unruptured aneurysms should be treated when >12 mm in the anterior circulation, >7 mm in the posterior circulation.
- NeuroICU admission, NSGY eval
- NIHSS score ***, GCS ***
- Hunt and Hess grade *** .
- WFNS grade ***
- ICU for q1h neuro checks
- Goal SBP <160, if aneurysmal SBP <140 (All should receive Nimodipine)
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Originally created: July 5, 2020 by Eric Lee
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