SAH¶
Symptoms¶
- Sudden headache
- Thunderclap headache
- diplopia
- loss of Vision
Management of Subarachnoid Hemorrhage (SAH)¶
The following steps are crucial in the management of SAH:
Initial Management¶
- Stabilize ABC (Airway, Breathing, Circulation)
Blood Pressure Control¶
- Target Blood Pressure (BP) is Systolic BP (SBP) <160 mm Hg
- Administer:
- Nifedipine 10 mg stat
- IV antihypertensives depending on the BP at arrival
Seizure Prophylaxis¶
- Administer antiepileptics to prevent seizures:
- Phenytoin 10–20 mg/kg IV
- Other antiepileptics as needed
Antifibrinolytic Therapy¶
- Administer tranexamic acid to decrease the rate of rebleed:
- Oral: 500–1,000 mg q8h
- IV: 1,000 mg over 10 minutes, followed by 1,000 mg infusion over 8 hours
Prevention of Vasospasm and Delayed Cerebral Edema¶
- Administer Nimodipine 60 mg PO q4h
Neurosurgical Referral¶
- Refer to Neurosurgeon for surgical management of:
- Aneurysm
- Arteriovenous malformation (AVM)
Additional Interventions¶
- An external ventricular drain (EVD) may be required to prevent hydrocephalus