Critical Care Scenarios Episode 22: Aneurysmal subarachnoid hemorrhage with Thomas Lawson
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Dec 27, 2020 The discussion starts with protocols for managing subarachnoid hemorrhage, emphasizing symptoms and risk factors. A detailed case study highlights the importance of blood pressure management in severe headaches and shock. Listeners learn about the urgency of CT angiograms to locate bleeding sources. The analysis of CT images offers visual indicators for diagnosis. The chat also dives into grading systems like Hunt and Hess for better patient outcomes. Lastly, managing complications like cerebral vasospasm is crucial for preventing neurological damage.
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CT Scan Interpretation
- When reviewing a CT scan for subarachnoid hemorrhage, look for the "hanging chicken sign".
- Also, check for intraventricular/intraparenchymal hemorrhage and hydrocephalus.
SAH Scoring Systems
- Use Hunt and Hess or WFNS scores to assess mortality risk in subarachnoid hemorrhage.
- Use the modified Fischer score to assess vasospasm risk.
Diagnostic Imaging
- If a CTA doesn't visualize the aneurysm, consider a traditional angiogram.
- CTAs are more sensitive for aneurysms than MRAs.