1 rich Libsyn https://www.libsyn.com 90 600 Subarachnoid haemorrhage is one of the most time-critical and high-stakes emergencies in medicine. But in the real world, it rarely presents neatly. In this episode, Oli Flower is joined by two AI co-hosts — Simon (GPT-5.3) and Claude (Sonnet 4.6) — to work through the pre-hospital and emergency department management of SAH using a real-world scenario: a 42-year-old woman with a thunderclap headache, collapse, and reduced GCS. What follows is a mix of clinical reasoning, practical decision-making, and occasional AI overconfidence getting corrected in real time. What we cover: Airway decisions in SAH: Is GCS 8 an automatic intubation? Pre-hospital priorities and seizure management Blood pressure targets: physiology vs reality ED workflow: stabilise first or scan first? Hyperventilation and ICP: when it helps and when it harms Communicating with neurosurgery (and what actually matters) Nimodipine: what the evidence really says (and doesn’t say) Why listen: This is not a guideline recitation. It’s a practical, frontline discussion of how SAH actually presents and how decisions get made under pressure — including where the evidence is thin, debated, or misunderstood. Along the way: Dogma gets challenged Nuance matters And one AI model learns, the hard way, what happens when you misquote trials Key takeaways: SAH management is a balance between competing risks: perfusion vs rebleeding Early decisions in airway, blood pressure, and transport matter Much of what we do is still based on physiology and consensus, not definitive trials And yes — sometimes you’re managing a brain with “buggered autoregulation” 🎧 If you work in emergency medicine, ICU, anaesthesia, or pre-hospital care, this episode will sharpen how you think about SAH from the moment the patient hits the floor to the CT scanner. 📍 ISAH 2026 — Sydney, 17–20 November Where these debates happen for real, with real humans. Neuro Resus http://www.neuroresus.com <iframe title="Libsyn Player" style="border: none" src="//html5-player.libsyn.com/embed/episode/id/41071570/height/90/theme/custom/thumbnail/yes/direction/forward/render-playlist/no/custom-color/88AA3C/" height="90" width="600" scrolling="no" allowfullscreen webkitallowfullscreen mozallowfullscreen oallowfullscreen msallowfullscreen></iframe> https://assets.libsyn.com/secure/content/201343980