This case was written by Dr. Martin Kuuskne from McGill University. Dr. Kuuskne is a PGY4 Emergency Medicine resident and one of the editors-in-chief at EMSimCases.
Why it Matters
This case highlights three important aspects of the management of a subarachnoid hemorrhage:
- Blood pressure control in an undifferentiated neurologic catastrophe
- Safe approaches to intubating a patient with possible acute hydrocephalus
- Management of a patient demonstrating signs of increased intracranial pressure
You are working an evening shift at a tertiary care centre emergency department with full surgical capabilities. A patient is brought into the resuscitation area by ambulance with decreased mental status. The patient was at the gym lifting weights; he complained of an acute headache to his friend and suddenly fell to the ground. The patient remained unconscious with sonorous breathing. The ambulance was called.
A 45-year-old male who suffered an aneurysmal subarachnoid hemorrhage while weightlifting presents to the emergency department requiring intubation for airway protection and develops acute hydrocephalus requiring ICP lowering maneuvers before definitive surgical management.