Medical Treatment: Analgesia if consciousness level is not impaired:
Paracetamol, oral, 1 g 4- 6 hours per day when required at a maximum of 4 doses per 24 hours per day.
If no responese: * Morphine, IV, 1- 2 mg / minute to a maximum 10 mg total dose.
Dilute 10 mg to 10 ml of 0.9 percent sodium chloride solution.
Repeat this 4 hourly.
Evite NSAIDs. In patients with grades 1 to 3 consciousness impairment waiting to be transferred to the neurochirurgical facility and in consultation with the neurochirurgist:
Nimodipine, oral, 60 mg 4 hours for 21 days.
When to refer:
All patients with low consciousness impairment for angiography and appropriate neurochirurgical treatment. Patients who were initially considered unsuitable for further investigation may be referred to later if their condition is improved.
For neurological imaging: patients in whom the diagnosis must be radiologically confirmed and in whom a lumbar puncture can be considered dangerous.