Friday, August 21, 2015

Hemorragia subaracnoidea

EM Didactics - August 17, 2015 - By Apoorva Chandra
A missed diagnosis could be the ‘worst headache’ of our lives!
"Let’s do a quick review of one of the major neurological emergencies - the deadly subarachnoid hemorrhage. Although traumatic SAH is the most common type presenting to the ED, in this review we will be dealing with only SAH of non-traumatic etiology as diagnosis and management. This in the ED is of paramount importance and any delay is associated with significant morbidity and mortality.

Take home points:
  • Ask them "Is it different from their previous headaches".
  • Ask for any headache preceding syncope!
  • Non contrast CT is highly sensitive if done within early hours of onset of symptoms and a CSF analysis confirms the diagnosis if CT is negative.
  • Reverse anticoagulants when INR > 1.4 and Antiplatelets when counts < 50,000."