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[pinipig523]

If it was a "sentinel bleed", then no. They'd probably look like a million bucks. However, at 2 weeks you probably wouldn't see xanthochromia, so you're hosed either way.

So what do I do? 2 weeks out and they look like a million bucks?

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[deleted109597]

So what do I do? 2 weeks out and they look like a million bucks?

2 weeks implies that it isn't sudden onset.
Thus, I usually don't care about SAH. If it was, as you said, they're dead (or immortal).
Droperidol/Compazine/Olanzapine/Reglan (your choice) and benadryl.

 

[Birdstrike]

We have tort reform in my state. You would think it would put an end to defensive medicine, but it doesn't. I have learned to be very careful about what questions I ask of my primary-care doctor, because he's becoming increasingly more liable to order additional tests in response, and I think it's mostly because he knows I'm a lawyer (and I represent physicians in malpractice cases!). Especially when my wife (who's a physician herself) expressed skepticism about whether I really needed the most recent one.

A no-fault med-mal system would help. But since trial lawyers are much, much more powerful politically than physicians, that's an extreme uphill battle. "Loser pays" would help, too. Doctors leaving states and specialties that are particularly toxic, will also help. In fact, this is the primary thing that has given traction to the tort reform that does exist; states that had been left with critical shortages of neurosurg, OB, etc. Doctors aren't helping anything by staying in jurisdictions where they are being sued constantly. In fact, that just feeds the problem. Although caps on damages are a necessary drop in the bucket, there are no easy solutions in the horizon.

Doctors: By staying in, and moving to, states and cities where med-mal is out of control, you are contributing to the problem. Your med-mal premium is funding it.

 

[Rendar5]

2 weeks into a headache I'm thinking pseudotumor, rebound headache, status migraine. and maaaaaybe in the back of my head tumor or sinus thrombosis. Either way, meds as above and neuro referall, and visual field check to make sure I've got time for outpt w/u on the 1st (though LP is the best h/a treatment in the first case, lol, only seen one done in the ED before for that indication)

 

[docB]

We have tort reform in my state. You would think it would put an end to defensive medicine, but it doesn't. I have learned to be very careful about what questions I ask of my primary-care doctor, because he's becoming increasingly more liable to order additional tests in response, and I think it's mostly because he knows I'm a lawyer (and I represent physicians in malpractice cases!). Especially when my wife (who's a physician herself) expressed skepticism about whether I really needed the most recent one.

A no-fault med-mal system would help. But since trial lawyers are much, much more powerful politically than physicians, that's an extreme uphill battle. "Loser pays" would help, too. Doctors leaving states and specialties that are particularly toxic, will also help. In fact, this is the primary thing that has given traction to the tort reform that does exist; states that had been left with critical shortages of neurosurg, OB, etc. Doctors aren't helping anything by staying in jurisdictions where they are being sued constantly. In fact, that just feeds the problem. Although caps on damages are a necessary drop in the bucket, there are no easy solutions in the horizon.

Doctors: By staying in, and moving to, states and cities where med-mal is out of control, you are contributing to the problem. Your med-mal premium is funding it.

These posts bring up a great discussion. I'm going to spin this off to a new thread.

 

[Foster23]

Why did they tap someone anti-coagulated?

INR needs to be <1.4

(Actually, based on where this appears to be going, I think it might be best legally, if I don't know.)

how far do you go with anticoagulation? Let's say the patient is not on coumadin, but is taking plavix or aggrenox? would you still tap? What about ASA? Thanks!

 

[pinipig523]

how far do you go with anticoagulation? Let's say the patient is not on coumadin, but is taking plavix or aggrenox? would you still tap? What about ASA? Thanks!

Check this...

It's not just warfarin... Our malpractice carrier analyzed data and advised us this:

Warfarin: wait 5-7 days and INR <1.4 (you can reverse with FFP to speed it up)

High-dose LMWH: wait 24 hours

Arixtra: wait 36 hours

Xarelto: wait 20 hours

Plavix/Effiant: wait 7 days, NOT reversed with platelets

Ticlid: wait 10 days, NOT reversed with platelets

Pradaxa/Danaparoid: unsafe, do not LP

This is based on their claims data, expert opinion by neurologists, etc. They will not cover claims where an LP occurs against their advice. They will also not cover claims for LP with platelets <50,000 (unless corrected), hemophilia (duh) or von Willebrand disease.

 

[Foster23]

Wow, this is exactly what I needed to know. Thanks!