How about the concept of: GCS 15, then worst case SAH Gd 1. Neurosurgeons
/ Neuroradiologists going to do something in the middle of the night for
this ? And she's been on warfarin ? Unlikely in our neck of the woods. Scan
will happen, thats a given:. But later, first thing in the morning or
earlier if a problem. Thats 8 hours, yeah 2 more than 6 from the paper
quoted. And everyone goes back to sleep. Then you dont lose a radiographer
the next day and everyong is fit for work the next day. Sorry Matt, no
party. (Radiologist's advovate you understand...)
John
----- Original Message -----
From: "Rowley Cottingham" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, March 08, 2012 2:30 PM
Subject: Re: loan severe headache
> No discernible neurology is a pointer TOWARDS SAH. The problem is more the
> migraineurs who can present with a sudden onset 'worst ever' headache.
>
> I missed a herald bleed in such circumstances as a junior many years ago
> and got roundly criticised. We do very few repeat CTs if the context is
> considered. I asked a neuroradiologist once how many scans it would take
> on a shunt patient (who get scanned at the drop of a hat) before he
> started getting concerned about radiation dose and he said he'd get
> concerned at the hundredth. Ever since I have been duly sceptical of the
> IRMER shroud-waving. Beware also of crying wolves.
>>
>> What if the patient had fibromyalgia, frequent attendances to the ED with
>> similar presentations and absolutely no discernible neurology? I
>> personally agree with the consensus view that the worse case scenario
>> needs to be outruled with immediate but as Matthew touched on earlier,
>> one
>> needs to consider the patient's examination as well as presentation.
>> Furthermore radiology registrars are often put under departmental
>> pressure
>> not to scan unnecessarily out of hours. This places an inordinate burden
>> of responsibility on them considering firstly that they can only make
>> decisions on the information provided them (from potentially
>> inexperienced
>> ED staff) and secondly that they themselves may not have sufficient
>> experience or sleep to either perform or read the scan out of hours.Will
>> Niven
>>
>> Date: Thu, 8 Mar 2012 11:31:41 +0000
>> From: [log in to unmask]
>> Subject: Re: loan severe headache
>> To: [log in to unmask]
>>
>>
>>
>>
>>
>>
>>
>>
>>
>>
>>
>> Should add: as the study authors say:
>> Computed tomography has unacceptably low sensitivity for subarachnoid
>> haemorrhage when it is performed after six hours from the time of
>> headache
>> onset
>>
>> To me that means if a patient presents within 6 hours and you delay the
>> scan you are pushing them into a more invasive and expensive
>> investigation. Even without
>> the issues around the anticoagulation that's probably worth getting the
>> radiographer up for.
>>
>> m
>>
>>
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>
>
> Best wishes,
>
> Rowley.
>
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