In general, unless contraindicated, we treat patients with Dilantin. Some neurosurgeons prefer phenobarbital, in light of its sedating effect, its effect on blood pressure, as well as seizure control. Phenobarbital can be given in 30mg aliquots with the upper limit of adequate levels around 300mg loading dose. Care must be maintained at high levels for respiratory arrest. Because one of the biggest fears is rebleeding, patients should be kept comfortable, in darkened and quiet surroundings, with stool softeners, and in an environment that is as nonstressful as possible.
Pain control can assist in making patients as comfortable as possible.
The objective should be eventual transfer to a medical facility where neurosurgical capabilities are present. Air evacuation is possible depending on logistics and the presence tertiary medical facilities. Using a Hunt classification of SAH severity for description may provide further valuable information for a neurosurgical colleague. The University of Iowa. All rights reserved.