A 52 year-old female is being transferred from an outside urgent care clinic to your tertiary care facility for altered mental status. Per the the paramedic's report the patient presented to the clinic about 1 hour ago with chief complaint of headache. Subsequently during her evaluation she became altered and combative. The treating physician called for an ambulance to have the patient transferred for higher level of care.
On arrival to the emergency department the patient is combative, moving her left side purposefully while withdrawing with her right side. Pupils are equal and reactive on exam. While awaiting your first set of vital signs you are told the patient's blood pressure at the clinic was 210/110. No other medical history is known about the patient. There was no family with the patient at the clinic.
A CT scan of the head is ultimately obtained and shown below:
What is the diagnosis?
How would you manage this patient?
Would you intubate? If so what agent(s) would you use for induction?
Please leave a comment below and share your thoughts.
The diagnosis for this case will be posted in approximately 1 week.
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