1. ED: Case Study Review
August, 2015
by Deborah Lynch, RN, MSN, APN, BC

2. Case Study
M.S is a 71 y/o right-handed male who presented to Rush’s ED on 11/18/14
His chief complaint(s) was sudden onset of headache, double vision and right-sided tingling sensation starting at 1300 while giving a lecture
Previous complaints and w/u for visual changes, dizziness, facial numbness; carotid disease (moderate bilaterally), MRI-microhemorrhages –r/t HTN)

3. Past Medical History
Hypertension HL
CAD-CABG
CHF
AVR
OSA
Colon cancer

4. Medications (PTA) Pitavastatin HCTZ Cozaar Toprol Aspirin 81mg/d MVI
**allergies: ramipril, simvastatin

5. Social History Non-smoker Married No recreational drugs
Retired Chicago policeman
Son with bipolar disease- recent increased level of stress

6. Initial CT head (non-contrast)

7. CTA head

8. CTA Neck

9. Circulation

10. CSF-Subarachnoid Space

11. Subarachnoid Hemorrhage (SAH)

12. Non-traumatic SAH Common causes- Aneurysms AV Malformations
Bleeding Diasthesis

13. Signs & Symptoms-SAH Nuchal rigidity Papilledema
Sicker than ischemic stroke
Bigger change in level of consciousness than ischemic stroke
Severe headache
May have severe nausea and vomiting

14. Hunt and Hess (SAH)

15. Time Line - ED
1300 Symptom onset
1648 ED Arrival
2119 NSICU Admission

16. BP Management Time BP Medication Dosing 1655 217/87 1752 Labetolol
20mg IVP
1756
188/72
1805
181/74
1849
179/82
1855
Cardene gtt
5mg/h
1922
159/75
1926
Cardene gtt
7.5mg/h
1939
10mg/h
1942
162/74
2028
132/64
2035

17. Progress Notes/Flow 1726 CT head
1737 MD Note; d/w NS rec: CTA, keppra,
sBP < 140, cardene gtt
1741 EKG interpretation
1756 CXR
CTA 1912