[##]-year-old [male/female] presents with [headache/altered mental status] with history and exam consistent with likely subarachnoid hemorrhage (SAH).
Initial considerations in this patient included SAH from ruptured
aneurysm, non-aneurysmal bleeding, and trauma, epidural and subdural
hemorrhage, intracranial mass, cerebrovascular accident (CVA), transient
ischemic attack (TIA), meningitis, encephalitis, and cerebral venous thrombosis
among others.
Patient presented [within 6/12/24 hours] of onset of
headache concerning for SAH. Patient noted
to have associated [neuro deficits/nuchal rigidity]. CT scan obtained [with/without] clear
evidence of SAH. A lumbar puncture [was
not performed due to clear evidence of SAH on CT/was performed with evidence of
xanthochrmia consistent with SAH/was not performed due to patient refusal/was
unsuccessful prompting us to obtain CT angiogram]. Patient was noted to have a Hunt & Hess
Grade [I-V] score as noted above on presentation to the ED. Patient noted to have [no] history of [anticoagulant
or antiplatelet/anticoagulant/antiplatelet] use with [no indication for reversal/reversal
of Coumadin initiated with prothrombin complex concentrate (Kcentra)/fresh
frozen plasma (FFP) and vitamin K/reversal of Aspirin initiated with DDAVP/reversal
of Plavix initiated with platelets/reversal of Dabigatran (Pradaxa) initiated
with Idarucizumab (Praxbind)].
Patient was intubated [due to respiratory failure/evidence
of inability to protect there airway] as noted above.
Patient noted to be hypertensive on presentation with
[some/minimal] improvement noted with administration of analgesics. Despite absence of clear consensus
recommendations on blood pressure control in the setting of SAH, we initiated treatment
with [Nicardipine/Labetalol/Esmolol] with a goal systolic blood pressure of
less than 160 mmHg [after consultation with neurosurgery].
Patient noted to be hypotensive on presentation with [IV
fluids given/IV fluids and vasopressors initiated] to maintain a goal mean arterial
pressure of greater than 80 mmHg.
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