clinical imaging Flashcards
define subarachnoid haemorrhage
arterial haemorrhage into subarachnoid space
risk factors of subarachnoid haemorrhage
hypertension smoking excess alcohol intake saccular aneurysms associated with - polycystic kidney disease - Marfan's - Ehlers Danlos
presenting symptoms of subarachnoid haemorrhage
sudden onset headache nausea/vomiting neck stiffness photophobia reduced level of consciousness
signs of subarachnoid haemorrhage on physical examination
meningism
- neck stiffness
- kernig’s sign
- pyrexia
GCS - check for deterioration
signs of raised ICP
- papilloedema
- IV/III nerve palsies
- hypertension
- bradycardia
focal neurological signs
investigations for subarachnoid haemorrhage
bloods:
- FBC
- U&Es
- ESR/CRP
- clotting screen
CT - hyper dense regions
angiography - detect source of bleeding
lumbar puncture
- increased opening pressure
- increased red cells
- xanthochromia (straw coloured CSF)
management of subarachnoid haemorrhage if GCS 8, <8, or falling
ABC
Call the anaesthetist
Cerebroprotective induction
discuss with a neurosurgeon for immediate transfer to a neurosciences centre/ HDU/ICU
target SpO2: 94% - 96% in acutely ill patients not at risk of hypercapnia.
- SpO2 of 88% to 92% if at risk of hypercapnic respiratory failure
restore normovolaemia
Avoid all hypotonic fluids.
supportive care and monitoring
nimodipine to prevent delayed cerebral ischaemia
consider:
- anticonvulsant
- stop and reverse anticoagulation
- endovascular coiling/surgical clipping
- ventriculostomy/lumbar drainage for acute hydrocephalus
management of subarachnoid haemorrhage if GCS 9+
supportive care and monitoring
nimodipine to prevent delayed cerebral ischaemia
consider:
- anticonvulsant
- analgesia
- stool softener and anti-emetic
- stop and reverse anticoagulation
- end-vascular coiling/surgical clipping
- ventriculostomy/lumbar drainage for acute hydrocephalus
