What to Do in Case of Subarachnoid Hemorrhage: Immediate Steps and Treatment Strategies
Subarachnoid hemorrhage (SAH) is a life-threatening medical emergency that requires immediate recognition and intervention. It occurs when bleeding happens in the space between the brain and the surrounding membrane, often due to a ruptured aneurysm. Early symptoms such as sudden, severe headache—often described as "the worst headache of my life"—nausea, vomiting, and altered consciousness should raise suspicion. Prompt action can significantly improve patient outcomes and reduce the risk of long-term complications.
Immediate Response and Emergency Care
1. Seek Emergency Medical Help ImmediatelyIf someone experiences a sudden, explosive headache accompanied by vomiting or loss of consciousness, it could be a sign of subarachnoid hemorrhage. Time is critical—call emergency services without delay. Rapid diagnosis and treatment are essential to prevent further neurological damage or fatality.
2. Position the Patient Correctly During TransportWhile waiting for medical help, position the individual with their head slightly elevated and lying on their side. This posture helps maintain an open airway and prevents aspiration if vomiting occurs. Avoid any unnecessary movement and keep the person as still as possible.
3. Clear the Airway if NecessaryIf the patient vomits, gently clear their mouth to prevent choking or inhalation of stomach contents. Never place anything in the mouth or attempt to give food or medication. Focus on maintaining breathing and circulation until professional help arrives.
Optimal Transport and Initial Management
4. Choose the Nearest Suitable Medical FacilityAvoid long-distance transfers unless absolutely necessary. The priority is rapid access to advanced neuroimaging and neurosurgical care. Hospitals equipped with CT scanners and neurointerventional teams are best suited for managing SAH cases. If transfer is unavoidable, ensure it's done under medical supervision with continuous monitoring.
5. Initiate Pre-Hospital Medical InterventionsIf trained personnel are available, early medical management during transport may include intravenous medications to control blood pressure and reduce intracranial pressure. Osmotic diuretics like mannitol may be used to decrease brain swelling. In some cases, mild sedation or pain relief can help reduce agitation and prevent spikes in blood pressure.
Blood Pressure and Neurological Monitoring
6. Minimize Physical and Emotional StressPatients must remain calm and avoid physical exertion. Anxiety and emotional distress can elevate blood pressure, increasing the risk of rebleeding. Healthcare providers may administer antihypertensive drugs to maintain optimal cerebral perfusion while avoiding hypotension.
7. Monitor Vital Signs CloselyContinuous observation of blood pressure, heart rate, oxygen saturation, and neurological status is crucial. Even small fluctuations can signal deterioration. Early detection allows for timely interventions to stabilize the patient before definitive treatment.
Definitive Diagnosis and Advanced Treatment
8. Confirm Diagnosis with ImagingUpon arrival at the hospital, a non-contrast head CT scan is typically performed first—it can detect blood in the subarachnoid space in over 95% of cases within the first 24 hours. If the CT is inconclusive, a lumbar puncture may be considered. Further evaluation with CT angiography (CTA) or digital subtraction angiography (DSA) helps identify the source of bleeding, most commonly a cerebral aneurysm.
9. Prevent Rebleeding and VasospasmOne of the primary goals of treatment is to secure the ruptured aneurysm to prevent rebleeding, which carries a high mortality rate. This can be achieved through either surgical clipping—where a metal clip is placed at the base of the aneurysm—or endovascular coiling, a minimally invasive procedure that fills the aneurysm with platinum coils to block blood flow.
10. Manage Delayed ComplicationsEven after securing the aneurysm, patients remain at risk for delayed cerebral ischemia caused by vasospasm—narrowing of brain arteries days after the initial bleed. Prophylactic use of calcium channel blockers like nimodipine, along with induced hypertension and volume expansion ("triple-H therapy"), may be employed to improve cerebral blood flow.
Preventing Long-Term Disability
Address Hydrocephalus and Support RecoveryHydrocephalus, or fluid buildup in the brain, affects up to half of SAH patients and may require temporary drainage via an external ventricular drain (EVD). Comprehensive care also includes seizure prophylaxis, nutritional support, deep vein thrombosis prevention, and early rehabilitation planning to maximize functional recovery.
In conclusion, subarachnoid hemorrhage demands swift recognition, expert pre-hospital care, and rapid access to specialized neurovascular centers. Through coordinated emergency response, advanced diagnostics, and timely intervention, survival rates and quality of life for patients can be significantly improved. Public awareness and education about warning signs play a vital role in reducing delays and saving lives.