Cannot miss / life threats
Cannot miss / life threats
Differential diagnosis — checklist
0/13
Check off each diagnosis as you consider it. Tap the name for unique exam, lab/imaging clues, first-line confirmatory test, and management.
Primary0/3
Secondary vascular0/3
Infectious0/3
Other0/4
Initial ED workup
Bedside0/3
- Full neuro exam
- Fundoscopy / IOP if eye pain
- BP, glucose, temp
Labs0/3
- CBC, BMP, coags
- ESR/CRP if > 50 yo (GCA)
- LP if SAH/meningitis suspected & CT negative
Imaging0/2
- Non-contrast CT head (within 6 h r/o SAH if ≥ 99% sensitive criteria met)
- CTA / CTV if dissection or CVST suspected
Initial management0/3
- IV antiemetic (metoclopramide / prochlorperazine) + IVF
- NSAID (ketorolac) ± triptan for migraine
- Empiric antibiotics + dexamethasone if bacterial meningitis suspected — do not delay for LP
Pearls / pitfalls
Pearls
- Thunderclap (max in < 1 min) → SAH workup
- Worst-of-life, exertional, focal deficits, fever, immunocompromised, > 50 yo with new HA = red flags