Dx: Subarachnoid hemorrhage

Risk factors include hypertension, smoking, polycystic kidney disease, family history, and connective tissue disorders.

Subarachnoid hemorrhages are related to ruptured arteriovenous malformations, bleeding disorders, cerebral aneurysms, trauma, use of blood thinners, and idiopathic causes.

Symptoms include but are not limited to sudden onset severe headache, decreased level of consciousness, vomiting, seizure, vision problems, numbness, and weakness.


If you need to intube, then get neurological exam prior to intubation.  Pre-treat with Lidocaine and Fentanyl in order to prevent reflex increase in blood pressure.

Control blood pressure.  If hypertensive, then give Cardene or Labetalol.  If hypotensive, then give fluids and pressors.

Give the patient an anti-vasospastic agent (ie. Nimodipine) and anti-seizure prophylaxis (ie. Phenytoin or Fosphenytoin)

Reverse coagulopathy of Coumadin (PCC and vit K), Aspirin (DDAVP), and Plavix (platelets).