Emergency Medicine Cases Ep 194 Subarachnoid Hemorrhage – Recognition, Workup and Diagnosis Deep Dive
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May 13, 2024 Join Dr. Jeff Perry and Dr. Katie Lin as they delve into the challenges of diagnosing subarachnoid hemorrhage, emphasizing the importance of early detection, key clinical clues, proper use of decision tools, indications for imaging tests and CSF interpretation. Explore the significance of evaluating thunderclap headaches, assessing risk factors for aneurysm rupture, and distinguishing various differential diagnoses. Understand the accuracy of non-contrast CT scans, Xanthochromia in CSF, and the implementation of decision tools for improved diagnosis and treatment outcomes.
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SAH Severity and ED Role
- Subarachnoid hemorrhage (SAH) has a high mortality rate, and many patients die before reaching the ED.
- Early diagnosis of SAH in the ED is crucial, as secondary bleeding and ischemia can worsen outcomes.
Traumatic vs. Spontaneous SAH
- SAH is classified as traumatic or spontaneous (non-traumatic), with different etiologies and management approaches.
- Trauma is the most common cause of SAH overall, but aneurysm rupture is the most common cause of spontaneous SAH.
Amnesia and Deep Space Blood
- Anton Helman discusses cases of patients with amnesia and deep space blood on CT, initially presumed traumatic.
- Neurosurgery recommended observation with repeat CT scan despite the unusual location of the bleed.