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Old 04-08-2012
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Neuro Subarachnoid Hemorrhage; Next Step?

An 81-year-old woman visits the emergency room complaining of the worst headache of her life. It radiates to the posterior neck and is worse with head movement. The pain began 2 hours ago. There are no other complaints. Medical history is significant for hypertension and two myocardial infarctions that occurred 5 and 10 years ago. Medications are enalapril, atenolol, and furosemide. On exam, blood pressure (BP) is 185/110 mm Hg. Nuchal rigidity is present. Neurologic exam is completely normal. The most appropriate next step is

A. Intravenous (IV) morphine sulfate
B. Obtain a computed tomography (CT) of the head
C. Obtain a lumbar puncture to rule out intracranial hemorrhage
D. Start IV nitroprusside
E. Treat the headache with sumatriptan (Imitrex)
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Old 04-08-2012
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answer. B .
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Old 04-08-2012
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B. CT head . to chek for Hmg. then treat medically acordinglyy
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Old 04-10-2012
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To investigate for SAH, first you do a CT scan (the answer)
in 15% of SAH the CT scan will be normal, so you have to do a LP after 12 hours. If the LP is not diagnostic then the patient has not had SAH
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