Critical Insights on Subarachnoid Hemorrhage and Chemical Ingestion

Show Notes

Take Home Points

1. In patients with APE, give high-dose nitro to decrease after load and preload quickly. 400-500 mcg/min for the first 4-5 minutes is my standard approach
2. Consider DSI to facilitate pre-oxygenation. Ketamine is your go to drug here
3. A NCHCT performed within 6 hours of symptom onset is extremely sensitive for ruling out SAH but, nothing is 100%. If you’ve got a high-risk patient, you should still consider LP
4. Patients with caustic ingestions can have rapidly deteriorating airways. Prepare early and be ready to take over the airway at a moments notice

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EMCrit: Delayed Sequence Intubation

Core EM: Setting Up Non-Invasive Ventilation

The SGEM: Thunderstruck (Subarachnoid Hemorrhage)

Friedman BW. Managing Migraine. Ann Emerg Med 2017; 69(2): 202-7. PMID: 27510942