canuckEMT Posted October 18, 2006 Posted October 18, 2006 I'm just saying that we don't know a thing yet. Presentation of "headache" (and my husband just left for work) could be anything from a subarachnoid bleed to bacterial meningitis to a hangover to she's lonely and wants to seduce us. We just don't know. Before I do anything, I want to be sure that it is an appropriate intervention. With just a little more info that can be garnered on scene pretty quickly, we can begin to get a little focus. We don't even know our intial impression of the patient yet. But just for pretend, lets say she's conscious, alert, oriented, good skin color/temp (don't even need pulse/ox - grab a finger & do a cap. refill) I just wouldn't feel a pressing need to begin O2 without delay. I would want some more info. But you're right, O2 wouldn't hurt. I'm just thinking its not an immediate priority, it may not even be necessary. Or maybe a NRB will be more appropriate. We just need to see more and hear more. I agree totally. If she is Ax0x4/4, speaking normally, no signs of cyanosis, good cap refill with strong reg radial pulse, why would O2 be a priority in this Pt so far? Of course with a HA you cannot rule out ischemic stroke, but need more information.
brock8024 Posted October 18, 2006 Posted October 18, 2006 Understand where you guys are coming from. I had seen where others had posted treatment. You guys are also right in the fact that o2 is not a important thing here but truly how many put o2 on while taking the HX. I was multi-tasking but you are right I did jump the gun on the meds.
ERDoc Posted October 19, 2006 Author Posted October 19, 2006 PMHx? What was she doing when it started? Can she localize it? Facial droop? Recently dx with htn, on meds. States, "It's under control." Right sided. No droop.
ERDoc Posted October 19, 2006 Author Posted October 19, 2006 Vitals, history, meds. Whats she look like? 153/88 66 RR14 100%RA Atenolol 25mg PO bid She's about 5'8", 135lbs, brown wavy hair down past her shoulders, sea foam green eyes, the perkiest... oh wait, I don't think that's what you are asking for. She looks pretty normal. As stated previously, no facial droop.
ERDoc Posted October 19, 2006 Author Posted October 19, 2006 What's her skin condition? Has this ever happened before? Does she have a fever? Is her neck sore or any px elsewhere? What was she doing last night (like drinking alcohol)? Past Hx, Meds, Allergies, when was the last time she ate, check a BGL. Is this the worst headache she has ever had? Rate this headache 1-10 scale. Set of vitals. Skin is warm and dry with good color. She states she has been having these headaches in the morning for the past week or two, on occasion they wake her up from sleep. They usually go away after she has been up for a while. No fever or neck pain. She states she had a can of Bud before going to sleep, otherwise has not had anything to drink since last Christmas. NKA. Last meal was about 7pm last night. BGL is 102. This is not the worst headache she has ever had, rates is about a 3-4.
ERDoc Posted October 19, 2006 Author Posted October 19, 2006 Any weird smells in the house? Breathing rate and quality? Pulses? PMH? Meds? Is it localized? Hx of HA before? Any nuchal rigidity? Does anything make it better? Has she been under alot of stress? What does she do for a living? Worse HA of life? How long has she had the HA? What was she doing when it started? Any photophobia? Any N/V? Does the pain radiate anywhere? Mother, Father, Siblings with HA problems or other medical problems? Smoke, Drug, Alcohol use? Tx so far will be IV hep lock, o2 at 3l/m via NC, call for either pain med or benadryl, and sometype of antiemetic if there is N/V. No wierd odors. Denies any signifiacnt stress. She works at a bank as a teller. She woke up with this headache about 30 minutes before calling you. No photophobia, some nausea no vomiting. The pain does not radiate. She is adopted and doesn't know her family history. No tobacco or drugs.
ERDoc Posted October 19, 2006 Author Posted October 19, 2006 Say: Why the hell couldn't you call a taxi, since you were going to drive to the ER anyway? She replies, "Listen civil servant boy. I pay your salary. Do your job and take me to the hospital in your metal chariot."
ERDoc Posted October 19, 2006 Author Posted October 19, 2006 I'm just saying that we don't know a thing yet. Presentation of "headache" (and my husband just left for work) could be anything from a subarachnoid bleed to bacterial meningitis to a hangover to she's lonely and wants to seduce us. We just don't know. Before I do anything, I want to be sure that it is an appropriate intervention. With just a little more info that can be garnered on scene pretty quickly, we can begin to get a little focus. We don't even know our intial impression of the patient yet. But just for pretend, lets say she's conscious, alert, oriented, good skin color/temp (don't even need pulse/ox - grab a finger & do a cap. refill) I just wouldn't feel a pressing need to begin O2 without delay. I would want some more info. But you're right, O2 wouldn't hurt. I'm just thinking its not an immediate priority, it may not even be necessary. Or maybe a NRB will be more appropriate. We just need to see more and hear more. I think I would like to meet some of the pts that you transport. O2 placed with no relief.
ERDoc Posted October 19, 2006 Author Posted October 19, 2006 I would want vitals, SAMPLE, pupils, O2 sat. Any sign of trauma? Smells in house or AOB for pt.? W/o any other info or history...I would consider various DX meningitis, migraine, hemorrhage/aneurysm, infection, stroke, carbon monixide. If the pt's aao a history would be very pertinent. Anyone else in the house? PERRLA. No signs of trauma. No smell in the house or on the pt. No one else in the house at the time. Husband left for work a while ago.
becksdad Posted October 19, 2006 Posted October 19, 2006 Is the pain always right sided? Does relief coincide w/ caffeine consumption? (just a thought....)
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