Headaches quiz - Ch 141 (billie) Flashcards
1
Q
what is the classic description of a SAH
A
sudden onset of HA at its maximal intensity
2
Q
what does the presence or absence of focal neuro symptoms depend on with a SAH
A
the location of the aneurysm.
3
Q
what are the risk factors for SAH
A
- excessive alcohol consumption
- polycystic kidney disease
- family hx of SAH
- marfans syndrome
- ehlers-danlos syndrome
4
Q
what is the initial diagnostic study to use when a SAH is suspected
A
Non-con Head CT
5
Q
how sensitive are CT scans to SAH
A
6-12 hours of SAH - 98%
24 hours - 91-93
1 week - 50%
6
Q
if SAH is suspected and CT is negative, what is the next step
A
lumbar puncture to assess presence of RBCs or xanthochromia
7
Q
when is the risk of rebleeding highest for SAH? how do we reduce this risk
A
- highest risk in first 24 hours.
- reduced w adequate BP control to an MAP of < 140 or to the BP of the pt prior to the hemorrhage.
- 10-20mg bolus IV labetalol over 1-2 minutes
- OR nicardipine 5mg IV continuous infusion titrated by 2.5mg/hr to a max of 15mg/hr
WikEM says only aneurysm tx is effective
8
Q
after BP control is initiated in SAH, what is the next step in care
A
- admit patient to ICU
- consult neuro
- admin nimodipine 60mg PO every 4 hours for vasospasm reduction
- reverse coags if needed
