QuestionSBA
QuestionChoice
A lumbar puncture may be performed if the CT head scan is inconclusive, but clinical suspicion for the subarachnoid remains high. Lumbar punctures are also helpful when patients present a while after headache onset, as the breakdown of red blood cells in the CSF can be picked up as xanthochromia.
10028218
c
Lumbar puncture
QuestionChoice
This may help alleviate the headache, but the first priority should be to rule out serious causes of the sudden headache.
10028219
d
Administer pain relief
QuestionChoice
This presentation raises concern for a potential subarachnoid haemorrhage, which is a medical emergency. A non-contrast CT head scan is the gold standard for ruling out a subarachnoid haemorrhage, especially considering this patient has presented within 6 hours of headache onset (CT head is almost 100% sensitive and specific for subarachnoid haemorrhages if performed within 6 hours of headache onset). It can quickly detect blood in the subarachnoid space.
10028216
a
Non-contrast CT head scan
QuestionChoice
This may help to relieve the patient's nausea and vomiting, but it should not replace investigation with a CT head scan.
10028220
e
Adminster an antiemetric
QuestionChoice
Waiting for reassessment is inappropriate in this case as it may delay the diagnosis and treatment of a potentially life-threatening condition.
10028217
b
Observation with reassessment
Concept
Chapter
2693
4193
Subarachnoid haemorrhage
Topic
141
Neurology
18041
A 45-year-old male presents to the emergency department with a severe occipital headache that started 3 hours ago. He has been experiencing vomiting but reports no sensitivity to light or neck stiffness.

He has no history of head trauma.

What is the most appropriate initial management option for this patient?
a