UMEM Educational Pearls

Category: Critical Care

Title: Aneurysmal SAH

Posted: 3/17/2009 by Mike Winters, MD (Updated: 4/1/2023)
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Early Critical Care Management of Aneurysmal SAH

30,000 patients per year have an SAH
Early ED management certainly should focus on airway assessment, emergent CT scanning, continuous caridac monitoring, and serial neurologic exams
A few other pearls regarding management:
- Volume management - maintain euvolemia with an isotonic crystalloid fluid
- Anticonvulsants - routine use is associated with cognitive impairment and is not recommended
- Steroids - once used to reduce meningeal irritation, however, there is no convincing evidence of a beneficial effect. As such, corticosteroids are no longer recommended.
- Rebleeding - risk of rebleeding is highest in first 24 hours after initial SAH. Definitive prevention is done by repair via surgery or endovascular coiling. A large, prospective study found outcome was better with endovascular coiling.

Diringer MN. Managment of aneurysmal subarachnoid hemorrhage. Crit Care Med 2009;37:432-40.