I agree with Paul. The case as presented appears clear cut. But often these patients arrive with little history, relatives on the way (?? when they will arrive) and a compromised airway - I dont feel that you can be ageist in your approach - there are a number of things which may be reversible and you need to deal with the airway. I dont know the odds - 1:5 , 1:10, 1:20 ? It may be hard to defend not tubing in retrospect - sure, most will be a big ICH, but some will not. I have no problem at all withdrawing treatment in the ED. My usual approach has been RSI with sux, light ongoing sedation and extubation following CT- I dont see the need for a long acting NMB or the need for ICU admission once youve got the diagnosis. I think there are too many what ifs.
Craig
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