subarachnoid hemorrhage maryland acep 2017 submission · lp cta mri + ‐ 6‐hour rule + ......
Post on 12-Sep-2019
5 Views
Preview:
TRANSCRIPT
3/20/2017
3
SEX
Did you really think I had a picture for that?????
NCCT
LP CTA MRI
+
‐
6‐hour rule
+ ?‐
Decision
3/20/2017
4
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!
3/20/2017
5
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
3/20/2017
6
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
3/20/2017
7
Vit K antagonistsAntiplatelet agents
Direct thrombin inhibitorsFactor Xa inhibitors
Which agent?When was last dose?
Treatment
Communicating hydrocephalus
Non‐Communicating hydrocephalus
top related