subarachnoid hemorrhage maryland acep 2017 submission · lp cta mri + ‐ 6‐hour rule + ......
TRANSCRIPT
3/20/2017
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(SUBARACHNOID)
HEADACHE
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SEX
Did you really think I had a picture for that?????
NCCT
LP CTA MRI
+
‐
6‐hour rule
+ ?‐
Decision
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Accurate timingIsolated thunderclap No meningismus
Normal neuro exam3rd gen scanner
No motion artifactCuts < 5 mm
Hematocrit > 30%Reading radiologist
Indication communicated
Perry BMJ 2015;350:h568
Differentiation Between Traumatic Tap and aSAH
RBC < 2000+
No Xanthochromia
100% sensitive!
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Ottawa SAH Clinical Decision Rule
Age > 40Neck pain or stiffness
Witnessed LOCOnset during exertion
Thunderclap headache (instantly peaking pain)Limited neck flexion on examination
Perry JAMA 2013;310:1248‐55
Edlow Ann Emerg Med 2008;52:407‐36
Connolly Stroke 2012;43:1711‐37
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NCCT
LP CTA MRI
+
‐
6‐hour rule
+ ?‐
Decision
Hemorrhagic Stroke <180‐<140, lower quicklySubarachnoid Hemorrhage <140, lower quickly
Ischemic Stroke <185, allow to stay highTraumatic Brain Injury >90, don’t let it drop!
Blood pressure targets
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Vit K antagonistsAntiplatelet agents
Direct thrombin inhibitorsFactor Xa inhibitors
Which agent?When was last dose?
Treatment
Communicating hydrocephalus
Non‐Communicating hydrocephalus
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Evie Marcolini MDAssistant Professor, Emergency Medicine and Neurology
Medical Director, SkyHealth Critical CareYale University School of Medicine