Once a patient’s acute SAH is diagnosed, emergency neurosurgical consultation should be obtained to arrange for definitive therapy for the ruptured aneurysm. In many cases, this will require transfer to a tertiary care facility. ED management should focus on airway management, close hemodynamic monitoring, supportive care, and prevention and treatment of complications. The numbers of clinical interventions are limited for SAH patients; however, outcomes have been shown to be best when care is provided by multidisciplinary teams in specialized centers.196 Few interventions for SAH management are unequivocally proven to be effective; rather, most are based on tradition and expert consensus. Table 12 depicts a sample protocol for SAH management based on the practices outlined in the AHA and NCS guidelines. Details should be discussed with the consulting neurosurgical team, as specific management practices may vary among hospitals and treating specialists or according to patient circumstances.
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