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Evidence-Based Approach To Diagnosis And Management Of Aneurysmal Subarachnoid Hemorrhage In The Emergency Department
Headache is the presenting complaint in roughly 2% of ED visits. Of all those with headache, about 1% will have SAH, meaning 99% of ED headache patients do not have SAH. This makes selecting those patients a major diagnostic challenge. Among those with sudden-onset, severe headache with normal neurologic examination, 10% to 16% have SAH. Diagnosing and accurately managing SAH remain pressing challenges for emergency clinicians. Estimates of misdiagnosis, previously as high as 32%, are now thought to be lower but still range from 5% to 15%. Patients with delayed diagnosis have worse outcomes, highlighting the importance of early recognition. Unfortunately, SAH claims the lives of 40% of its victims and leaves 30% with substantial neurological disability.
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Pediatric Fever And Neutropenia: An Evidence-Based Approach
A complete blood cell count (CBC) is often ordered by emergency department (ED) staff in an effort to better define a disease process
or assign risk to a patient`s illness. The ED clinician must be prepared
to manage the CBC results even when they are abnormal or not easily explained. One of the most worrisome abnormal findings in children is pediatric neutropenia, defined as an absolute neutrophil
count (ANC) less than 1500/µL. Neutropenia can represent an increased risk for invasive disease and have an etiology that is not always readily apparent, especially when accompanied by a fever.
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