| Talking & obeying | | |
| CT scan confirms SAH (no haematoma) | → | Discuss with neurosurgeon and transfer as soon as reasonably possible |
| or | | | |
| CT negative → Lumbar puncture +ive | | |
| No speech and/or localising | | |
| CT scan confirms SAH | → | Discuss with neurosurgeon and transfer ASAP |
| Flexing or worse | | |
| CT scan confirms SAH | | |
| Moribund since ictus | → | Discuss with neurosurgeon delay transfer |
| Hydrocephalus or haematoma | → | Discuss with neurosurgeon |
| Management where no CT scanner available (not reproduced here) | | |
|
On contacting neurosurgical unit:
| |
Management in DGH
|
|
Give:
| Patient's age | | Resuscitation—`A,B,C.' |
| Previous medical conditions | | IV fluids—3 litres per day |
| History | | BP—control extremes |
| Glasgow coma score | | Nimodipine 60 mg 4 hourly |
| Focal signs | | Analgesia paracetamol/codeine |