Describe your initial management of patient with suspected SAH?

Resuscitation & Supportive Care
  • Consider need for intubation:
    • Intubation if not maintaining airway
    • May require semi-elective intubation if not protecting adequately or for neuroprotective measures
    • Tape tube in position
  • Manage hypertension / hypotension
    • Until aneurysm secured target systolic blood pressure <180mmHg-160mmHg (ESO/AHA)
    • If required use a titratable IV antihypertensive and invasive arterial monitoring
    • Maintain MAP >90mmHg (ESO)
  • Manage arrhythmias
  • Manage seizures with benzodiazepines, phenytoin and levetiracetam
  • Instigate appropriate neuroprotective measures:
    • Maintain CO2 4.5-6.0 kPa, pO2 >10
    • Sit up, avoid neck lines
    • Analgesics, laxatives, antiemetics to reduce ICP
  • Maintain glucose 6-10mmol and temperature <37.5
  • Careful management of fluids:
    • Urinary catheter and fluid balance monitoring for all patients
    • Aim for euvolaemia
  • Reverse any coagulopathy
  • DVT prophylaxis:
    • Mechanical methods until aneurysm secured
    • LMWH >12 after surgical clipping