subarachnoid hemorrhage questions

[SNtil11]

hey there - i have a question about my pt from last week, and thought you would be able to help. Pt. is 7 years old and was hit in an auto vs. pedestrian accident. let me start off by saying is is in very stable condition and probably at home and back at school - so no worries. I am just working on paper work... and patho write up. His H&P stated that the CT scan found subarachnoid hemorrhages that collected in the sulci and no fractures. It doesn't say hematoma, it says hemorrhages. Do these just stop and clear up on their own? he was fine with neuro checks, and his orders stated ok to ambulate... so... is this something that is not worrisome? I mean, it sounds scary, but from the report, and my shift with him, it seems as though its not a big deal and is something that will clear up on his own - am i right? he is on no other meds/treatments/or restrictions, just an abrasion on his back and the obvious scrapes and bruising. Any words from the wise on this? thanks!

[curiosity123]

Here is a link to an article that will help answer questions about SAH

http://emedicine.medscape.com/article/794076-overview

[bajamedic]

Yep.......that is a good link. First think about the anatomy of the skull, you know sub-dural- sub-arachnoid. Then look at the bleed. If it is a large bleed then...surgery. If not then? Your statement of the Pt having no CNS deficit......that is good sign. So........when the DOC looked at the CT scan he saw the size of the bleed.........that with the Pt assessment and nuero assessment.........he wrote his orders.........ok to ambulate. From there I would get a clear picture of Hematoma and a hemmorrhage(bleed). You are on the right track. It is trauma, one thing you might find interesting....would be to know what was this pt glascow coma score when he came to the ED. If it was low then...........? If it was High say 14............then?. This is the big picture. This is why the Medics give a Pt report to the MICN then the doctor can see if the pt is improving or not. I would Say this kid had a good GCS comming into the ED. Remember the big Picture with trauma.

this is more on point http://www.medscape.com/viewarticle/542508_3

It is realted to trauma. Your patho issue is SAH.........Trauma.......MOI...MV v. Pedestrain. Was it high speed? Low Speed. E=mc2 the engery transfer to this kids head was low. If it had of been high..........it would not have been a good day. The DOC was aware of all the info, including the Pre-hospital run report which gave him a big picture of what happend. Then he made is order based on the big picture.

[SNtil11]

thanks for your help! I will check out the link right now. and yes, his GCS was 15 when coming in... so no probs there. :) Thanks for the explanation, it's making a lot more sense now :)