Subarachnoid haemorrhage

Question 1

Airway

Answer 1

Might affect airway if high ICP causing low GCS <8 intubate

Question 2

Breathing

Answer 2

Look: respiratory effort
Listen: breath sounds
Feel: chest expansion, tracheal deviation, percussion

RR, O2

CXR, ABG

Question 3

Circulation

Answer 3

Look, listen, feel
HR BP

ECG
IV access
Bloods: FBC, UEs, LFTs, CRP, clotting, group and save, clotting

Question 4

Disability

Answer 4

GCS
PEARL
focal neurology
BM
CT head stat
Fundoscopy (see if there is raised ICP)
Drug chart to see if on anticoagulation
LP ONLY if CT negative and history suggestive - xanthochromia, haemmoragic CSF

Question 5

Definitive Mx

Answer 5

Definitive: GCS <9
* Intubate + ventilate
* BP: aim for SBP 120-160, if low support using IV fluids, caution if high, consider labetalol
* Nimodipine 60mg 4 hrly via NGT: reduces vasospasm and cerebral ischaemia
* Neurological observations: pupil checks every 20 minutes, BP, GCS
* Surgery = endovascular coiling vs surgical clipping (requiring craniotomy)

GCS >=9
* BP, nimodipine as above Analgesia
* Anti-emetics
* Neurological observations

Question 6

Escalation

Answer 6

Alert radiology
Contact anaesthetics
Contact neurosurgery
Contact ITU