Bad Headache

[skinut2234]

Got dispatched to call for 39 yr old male with "headache" Upon arrival as assessment- no other complaints or findings.

Pt. stated pain scale 8 out of 10... My partner suggestion full neuro exem... Outside of checking things like facial droop and also weakness to one side or the other- what else can I look for to rule out CVA? What type's of other tests can I do?

[Airmedic999]

I tend to look at conscious level, neurological signs, BP, HR and rhythym(AF in particular),heart murmurs, peripheral pulses and signs of infection.Taking into consideration that 85% of CVA comes from ischaemia..i.e embolic event or artherothrombotic occlusion...MI and failure etc

[Ridryder 911]

HX. HX. HX.... as well as checking neuro evaluation.. I attached a link for neuro exam. It is crucial for the Paramedic to have a knowledge of how to perform the assessment and a FULL understanding of the findings of each. There are so many times I see EMT's bring in patients with unilateral hemiplegia that they described having = & full grips. Not understanding grips should be checked with the arms being held outstretched, not laying in the lap as some perform. Use the Cincinnati or L.A. Prehospital Stroke Scale, learn either one by heart. Physicians should be familiar with either one.

There is a great on -line free CEU course for recognition and tx. of CVA, I will try to locate the web site.

Again, we ingrain check pupils for reactivity, etc.. with no emphasis what an abnormal finding means or what to do.

EMS falls very short in neuro evaluation, hopefully there will be better education on these areas.

neuro exam link : http://medinfo.ufl.edu/year1/bcs/clist/neuro.html

Be safe,

R/R 911

[ERDoc]

Headaches require a great deal of history. Onset? Location? Quality? Previous headaches? Recent trauma? Visual disturbances? Photophobia? Hyperacusis? You can get more info out of a good, detailed hx than you will get from physical.

[Ridryder 911]

As I posted, I aree with ER Doc.. part of the problem (other than not knowing how to do thorough patient assessment) is EMT's do not routinely obtain history. There is much that can be obtained while enroute.

Be safe,

R/R 911

[ERDoc]

The same questions that you ask someone with abd pain or chest can be asked of headaches. Do they radiate? Does anything make them better or worse? Is there a certain time of day when they occur?

[fireman_gcfd]

Hey There

Here's a strange "Headache"call we attended. The Hx we recieved from the pt and dispatch information...25yo male @ the recreation center with complaint of headache and weakness. On arrival pt found in mens washroom lying on floor. Limited speech but complained of a headache and nausea. His pain when asked was lower occipital region. Upon further questioning the pt gave us the story of: "I was working out doing leg squats and pushed hard on my last set. Got a terrible headache and felt dizzy. When dizziness did not subside, I went to the bathroom where I became violently Ill with continuous vomitting. Shortly after losing 80% of motor skill and speech".

During assessment, it was found that all vitals were well within normal parameters, pupils equal and reactive but body temperature was 34.4C. Pt still complained of his headache but nausea had subsided and was gaining strength again. Upon arrival at the ER, Dr's assessment also revealed that pt was unable to track items or focus on a single object. Eyes just wouldn't agree with each other! All the regular questions were asked, last meal (didn't eat yet that day), family Hx (diabetes, epilepsy,etc), drugs or meds. Nothing out of the ordinary. Temperature had come back into normal range and Pt described himself as feeling much better, other than a slight headache. Full motor skills and eyes were slowly returning to normal state.

Out of precaution, Dr. ordered a CT just out of curiosity. Low and Behold, this guy had a severe bleed subderal and was immediately taken into surgery.

Who would have thought? A headache call turning into something like that!! I will never look at it again as "Just another Headache Run" again.

Cheers

Jaz

[Dustdevil]

Low and Behold, this guy had a severe bleed subderal and was immediately taken into surgery.

Who would have thought? A headache call turning into something like that!!

I would have. In fact, that was my immediate impression from your first paragraph.

Great case presentation, GC! It is a reality check for all those people out there who think that training is more important than education, and that only skills separate basics from medics.

[AZCEP]

The same questions that you ask someone with abd pain or chest can be asked of headaches. Do they radiate? Does anything make them better or worse? Is there a certain time of day when they occur?

I will use the OPQRST for any pain. Then add system specific questions as needed. With a headache, ask them to compare it to previous episodes, if possible. Changes in level of pain, location, associated problems can be very important. Ask bystanders/family members about any changes in mental status. The patient tends to be a poor historian about their own mental status.

[bandaidpatrol]

Bob's Quick.. well sort of.. CVA Test. Sometimes I do it on myself.., because you never know.

Start from the top and go down.

Look at the pupils

Have them wink

Have them give you a big grin

Have them stick out their tongue

Look at the face

JVD?

Have them hold out their arms

Have them squeeze your hands, both at the same time

Have them press and pull with thier feet

Finally.

Have them say "Precipitation floods the Mississippi" good words to detect a slur. Or something simple, if they are having a full blown CVA, and you can't pick up on it, simple words such as answers to normal questions should complete the survey.