JSK - SAH

Aneurysmal Subarachnoid Hemorrhage - Source *** Grade: H/H *** mF *** Vasospasm (mF ***) - *** Risk Hydrocephalus - Non-obstructive

  • Obtain baseline EKG and Troponin - if either abnormal order TTE to assess for - Nimodipine 60 mg PO Q4 hours for 21 days
  • Maintain hemoglobin between 8-10 g/dl
  • Maintain Magnesium greater than 1.6
  • Maintain serum glucose < 180 using Sliding Scale Insulin
  • Monitor for Hyponatremia
  • Monitor for seizure activity
  • Hold antithrombotics and anticoagulants
  • Holding chemical DVT prophylaxis until aneurysm secured
  • Continue statin therapy if patient was previously taking prior to SAH
  • Transcranial Doppler (TCD) daily during peak vasospasm period
  • Monitor for symptomatic vasospasm and delayed cerebral ischemia (DCI)
  • Maintain Euvolemia with strict monitoring of I/Os post Bleed day 3
  • I/O Matching Q4 hours post Bleed day 3
  • EVD set at 20 cmH20 before aneurysm secured
  • EVD set at 15 cmH20 before aneurysm secured