Subarachnoid hemorrhage diagnosis-what to do J. Stephen Huff, MD Fourth-Year student elective director Professor of Emergency Medicine and Neurology University.

Slides:

Advertisements

Similar presentations

New Onset Headache: Diagnosis and Management

Advertisements

Subarachnoid Hemorrhage Nina T

Obstetric Emergencies Postpartum Hemorrhage and Hypertension Annelee Boyle, MD, FACOG Assistant Professor Department of Obstetrics and Gynecology Division.

Aneurysmal Subarachnoid Hemorrhage

Subarachnoid Hemorrhage. subarachnoid space ventricles.

Massive transfusion: New Protocol

FERNE / MEMC Acute Headache & Aneurysmal Subarachnoid Hemorrhage How Can We Optimally Manage Patients & Exclude SAH? William Brady, MD Professor of Emergency.

Sudden Headache and Unresponsiveness in a 10 year-old boy Sudden Headache and Unresponsiveness in a 10 year-old boy J. Stephen Huff, MD, FACEP Emergency.

Major Pelvic Trauma Bernard Foley FACEM Department of Emergency Medicine Auckland Hospital Wednesday, 13 May 2015Wednesday, 13 May 2015Wednesday, 13 May.

J. Stephen Huff, MD ED Stroke Patient Management: What must we be able to do in order to provide tPA in the ED? (mimics, stroke scales, timing, and CT.

Aneurysmal subarachnoid hemorrhage : recent updates

Nina T. Gentile, MD Associate Professor Department of Emergency Medicine Temple University Hospital & School of Medicine Philadelphia, PA Nina T. Gentile,

ACEP Clinical Policy: Adult Headache Patients. Ponte Vedra Beach, FL June 24, Clinical Decision Making in Emergency Medicine Ponte Vedra Beach,

Dr Ali Tompkins,ST6 East and North Herts Hospitals Sensitivity of Computed Tomography Performed Within Six Hours of Onset of Headache for Diagnosis of.

J. Stephen Huff, MD, FACEP Transient Ischemic Attack Patient Update: The Optimal Management of Emergency Department Patients With Suspected Cerebral Ischemia.

Richard Shih, MD, FACEP The Diagnosis and Management of ED Headache Patients: When Must Cranial CT and LP Both Be Performed in Order to Exclude the Diagnosis.

J. Stephen Huff, MD, FACEP J. Stephen Huff, MD Associate Professor Department of Emergency Medicine University of Virginia Charlottesville, Virginia.

E. Bradshaw Bunney, MD, FACEP The Diagnosis of SAH in ED Headache Patients: What Roles for CT Neuroimaging and Lumbar Puncture?

Antibiotic overuse and misuse in long term care Shira Doron, MD Assistant Professor of Medicine Division of Geographic Medicine and Infectious Diseases.

A Case of a Thunderclap Headache Andy Jagoda, MD, FACEP.

Cristina Caterina Aldea Scientific Coordinator: Professor Ioan Ştefan Florian MD, PhD “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca.

Research Design: The Progression of Study Designs that Address a Clinical Question.

Evidence Based Medicine and Medical Decision Making Iztok Hozo, Professor of Mathematics Indiana University Northwest European School of Oncology How to.

Morbidity and Mortality Rounds Subarachnoid Hemorrhage Diagnostic Challenges in the ED Neil Collins.

CNS Panel CNS Alphabet Soup: CVA, ICH, SAH Patient Case Presentations, ED Diagnosis and Management.

Telephone Triage for Stroke by Ambulance Services in the U.K. Summary and Comment by J. Stephen Bohan, MD, MS, FACP, FACEP Published in Journal Watch Emergency.

Shira Doron, MD Assistant Professor of Medicine

Emergency Intubations for Trauma: One Center's Experience Summary and Comment by Ron M. Walls, MD, FRCPC, FAAEM Published in Journal Watch Emergency Medicine.

The Role of Thromboprophylaxis in Elective Spinal Surgery The Role of Thromboprophylaxis in Elective Spinal Surgery VA Elwell, N Koo Ng, D Horner & D Peterson.

Patient # 3 = Lab Results Your Results: Head CT: Normal LP:

Open Heart Surgery Patient Information Dr. Donald L. Bricker MD and Cheryl B. Hunt 2010.

Subarachnoid Hemorrhage in Type 1 Diabetes A prospective cohort study of 4,083 patients with diabetes Featured Article: Miikka Korja, M.D., P.H.D., Lena.

Andrew W. Asimos, MD How Can We Use Advanced Neuroimaging in the ED to Optimize Treatment Options for Acute Stroke Patients?

(or “How I learned to stop worrying and love computed tomography”)

EP Discordance of CTA and Digital Subtraction Angiography in Diagnosing Vasospasm Following Subarachnoid Hemorrhage ASNR 53 rd Annual Meeting – April.

Morgagni Hernia Brian Belyea Radiology Elective Block 8 February 27, 2004.

Edward C. Jauch, MD, MS FACEP 1 Research Horizons in the Acute Management of ICH.

Stroke Module Scene B – CT Scan. Scene B Introduction Mr. Jones has been prepped and readied for his CT scan to see if his headache is being caused by.

12/6/20151 Cochlear implants in the older patient Mark Pyle MD Professor of surgery and Academic Vice Chair Division of Otolaryngology.

The Diagnosis of SUBARACHNOID HEMORRHAGE Rob Hall PGY2 Emergency Medicine January 10th, 2002.

X3D: Real Time 3D Solution for the web Web3D Tech Talk – Aug 13, SIGGRAPH 2008 X3D: Real Time 3D Solution for the web Web3D Tech Talk – Aug 13, SIGGRAPH.

Subarachnoid Hemorrhage Nina T. Gentile, MD Associate Professor Division of Emergency Medicine Temple University School of Medicine Philadelphia, PA.

Informed Consent Part 1: General Principles Part 2: Risks and Alternatives Related to Central Venous Catheter Insertion Office of Graduate Medical Education.

Validation and Refinement of a Prediction Rule to Identify Children at Low Risk for Acute Appendicitis Kharbanda AB, Dudley NC, Bajaj L, et al; Pediatric.

Safety of Cerebral Digital Subtraction Angiography in Pediatric Patients with Sickle Cell Disease. Emily Wyse, BS 1 Jessica Carpenter, MD 2 Suresh Magge,

Management of Spontaneous ICH Corey Heitz, MD Director, Undergrad Med Ed Assistant Professor, Emergency Medicine.

Young Woman With Abdominal Pain David Jones, MD Annals of Emergency Medicine Volume 64, Issue 4, (October 2014) DOI: /j.annemergmed

Post contrast CT extravasation is associated with hematoma expansion in CTA spot negative patients A Ederies, A Demchuk, T Chia, et al Stroke 2009;40:

Transradial Access Complication How to Treat and Avoid Howard A. Cohen, MD, FACC, FSCAI Professor of Medicine Director Temple Interventional Heart & Vascular.

Presentation: eP-26. There is no conflict of interest in this presentation.

Repair of a Thoracic Aorta Aneurysm

Volume 1, Issue 1, Pages 8-10 (March 2014)

Department of Emergency Medicine Kevin Biese, MD, MAT

UAB School of Medicine: MD Core Curriculum Schematics

Case Discussion Farzad Rahmani

Managing Nontraumatic Acute Back Pain

Stephen W. Smith, MD Annals of Emergency Medicine

MACE rate among CAD severity groups (total 0

Precise capture of thoracic morbidity and mortality: Essential to the process and culture of quality improvement Anna L. McGuire, MD, MSc, FRCSC, John.

Young Woman With Abdominal Pain

Woman With Sudden-Onset Headache

Please add these slides to

Intracerebral Hemorrhage

Figure 2 Spectrum of abnormal CT scanning of patients with bacterial meningitis presenting with a minimal Glasgow Coma Scale score Spectrum of abnormal.

Summary of 2002 data. Summary of 2002 data. All patients with head injuries (HI) for the nine month control period are included. The new protocol was.

Summary of 2001 data. Summary of 2001 data. All patients with head injuries (HI) for the seven month control period are included. Royal College of Surgeons.

(A) The right precordial leads V1 to V3 in a chest pain patient ultimately diagnosed with AMI. (B) Additional posterior leads V8 and V9 reveal STE, confirming.

Circulatory System Diseases

Non-contrast head CT (A) showing diffuse subarachnoid hemorrhage and hydrocephalus. Non-contrast head CT (A) showing diffuse subarachnoid hemorrhage and.

Quality Improvement and Patient Safety Forum

Presentation transcript:

Subarachnoid hemorrhage diagnosis-what to do J. Stephen Huff, MD Fourth-Year student elective director Professor of Emergency Medicine and Neurology University of Virginia Virginia College of Emergency Physicians Hot Springs, Virginia 2016 Corey Heitz, MD Director, Undergraduate Medical Education Assistant Professor of Emergency Medicine Virginia Tech Carilion

Disclosures none

Objectives Rule out SAH without performing an LP every time!

What are we looking for? Aneursymal SAH or Non-aneurysmal SAH

Aneurysmal SAH High morbidity and mortality Possibility of “sentinel bleeding”

Non-aneurysmal SAH Aka perimesencephalic SAH Usually venous Minimal long term effects

Point #1: We aren’t just looking for blood, we are looking for aneurysmal bleeding

Testing algorithm POSITIVE: NO LP NEGATIVE, LP POSITIVE NEGATIVE, LP NEGATIVE CT angio done

Proposed revision POSITIVE NEGATIVE* CT Angio (CTA) DONE Angio (CTA)

Let’s talk about LP Invasive Sometimes painful Complications Doesn’t diagnose aneurysm!

But if it’s a good test… 2 true positives in 302 patients ~1 in 200 after negative head CT

Risk/Benefit NND: NNH: 10-20

Point #2: LPs are low yield, high adverse effects

But is CT good enough? Perry et al 2011: 953 patients CTed within 6 hours: all SAHs diagnosed Backes et al 2012: validated sens/spec of 100%

But is CT good enough? Dubosh patients 13 missed SAH on CT 1.46 per 1000 CTs LR- for CT: ( ) NND for LP: 700

Proposed revision POSITIVE NEGATIVE* CT Angio (CTA) DONE Angio (CTA)

Proposed revision POSITIVE NEGATIVE* CT Angio (CTA) DONE Angio (CTA)

Proposed revision POSITIVE NEGATIVE* CT Angio (CTA) DONE Angio (CTA)

Proposed revision POSITIVE NEGATIVE* CT Angio (CTA) DONE Angio (CTA)

Summary LPs are low yield and fair # of complications CT within 6 hours is excellent Positives go to angio anyway 700 LPs to diagnose 1 missed bleed? Insane