Treatment of subarachnoid haemorrhage
ABCDE
Intubation if necessary. Low threshold for ITU involvement
Supportive therapy
Fluids, controlled oxygen
Keep platelets over 100
Early discussion with neurosurgery (see below)
Reverse anticoagulation no matter what the indication for it
Rapid treatment of BP is not recommended. Keep systolic under 180 or MAP under 130. Aiming for systolic<140 (NEJM 2013).
If BP contol is needed acutely, ITU for labetolol is appropriate
Nimodipine 60mg 4hrly for everyone (prevents vasospasm)
Reduce dose to 30mg 4 hourly if bP 100-140; withold of BP under 100
If vasospasm occurs (stroke-like syndrome) consider:
3H treatment (hypertension, hypervolaemia and haemodilution)