CT available in referring hospital
Talking & obeying
CT scan confirms SAH (no haematoma)Discuss with neurosurgeon and transfer as soon as reasonably possible
CT negative → Lumbar puncture +ive
No speech and/or localising
CT scan confirms SAHDiscuss with neurosurgeon and transfer ASAP
Flexing or worse
CT scan confirms SAH
Moribund since ictusDiscuss with neurosurgeon delay transfer
Hydrocephalus or haematomaDiscuss with neurosurgeon
Management where no CT scanner available (not reproduced here)
On contacting neurosurgical unit: Management in DGH
Give: Patient's ageResuscitation—`A,B,C.'
Previous medical conditionsIV fluids—3 litres per day
HistoryBP—control extremes
Glasgow coma scoreNimodipine 60 mg 4 hourly
Focal signsAnalgesia paracetamol/codeine