What should you do immediately for someone suspected of subarachnoid hemorrhage?

• A. Administer oxygen, place IV line, do an EKG, and prepare for cerebral angiogram to locate site
• B. Give aspirin and imaging
• C. Observe and repeat in 24 hours
• D. Administer nitroglycerin only

Answer: (A)

Immediate stabilization and rapid localization of the bleed source are crucial. For someone suspected of subarachnoid hemorrhage, start with ensuring adequate oxygenation by giving supplemental oxygen, because brain tissue needs good oxygen delivery. Secure IV access right away to start fluids and medications and to support monitoring and treatment. Continuous cardiac monitoring and an EKG are essential, since acute SAH can cause neurogenic cardiac changes and rhythm disturbances, and knowing the baseline rhythm guides further care. After stabilization, proceed with urgent imaging to identify the bleed and locate the source, typically starting with a head CT and then moving toward vascular imaging to pinpoint an aneurysm or malformation; preparing for a cerebral angiogram is a critical step in this workup so definitive treatment can be planned promptly.

Giving aspirin is contraindicated in suspected intracranial hemorrhage because it worsens bleeding. Observing and waiting 24 hours delays potentially life-saving treatment. Administering nitroglycerin alone does not address the need for rapid stabilization and definitive localization of the bleed.