Rosemarie Brown

A 25-year-old Aboriginal Australian woman presents to the emergency department with sudden onset of the worst headache of her life (thunderclap headache), with nausea, vomiting and neck stiffness. Take a focused history, perform a relevant neurological examination, and initiate appropriate management.

1. 1Take a focused history of the headache including SOCRATES
2. 2Identify red flag features suggesting subarachnoid haemorrhage
3. 3Explore relevant past medical, family and social history
4. 4Verbalise a focused neurological examination
5. 5Order and justify appropriate investigations (non-contrast CT, LP)
6. 6Provide a working diagnosis with severity assessment
7. 7Initiate acute SAH management including stabilisation and neurosurgical referral
8. 8Provide reassurance, prognosis information and safety-net advice