Transport priority for hypertensive emergency?

[1EMT-P]

I had a case similar to this case about six years ago. The lady was 52 y.o. with a history of Asthma, Anxiety, Depression, GERD, High Cholesterol, HTN x 20 yrs. and a Pacer for Tachy-Brady Syndrome. The lady was on Albuterol PRN, Ativan, Lasix, Lipitor, Paxil, Pepcid PRN and Verapamil SR. She went outside and walked down some steps at her house and developed what she called the worst headache of her life. She rated her pain as 10/10. Her vs were as follows BP 210/120, P 120, RR 20, SPO2 95% on Room Air. The patient was given supportive care and transported to the ED. At the ED she was assessed, a Stat CT was ordered and labs were ordered. Prior to going to the CT the patient complained of nausea and was given IV Compazine. She was transported to the CT where a diagnosis of SAH was made. The patient was given IV Ativan and was flown to a larger teaching hospital with a Stroke Team. Upon arrival in the ED she was given SL Procardia and an Art Line was placed and she was transferred to the SICU under the care of Neurosurgery. Over the course of the next 9 days the patient was given Nimtop and monitored until she was discharged on both Lopressor and Nimtop.

[1EMT-P]

Anytime you have a patient with a history of HTN complaining of a severe headache 10/10 and/or the worst headache of their life it is best to assume that the patient is having a CVA and/or SAH until proven otherwise.

[Ridryder 911]

Anytime you have a patient with a history of HTN complaining of a severe headache 10/10 and/or the worst headache of their life it is best to assume that the patient is having a CVA and/or SAH until proven otherwise.

With that in mind, I have enclosed the MEND's assessment checklist. The Advanced Stroke Life Support is attempting to promote such repeated criteria. It is more simplistic and informative than the Cincinnati and other stroke scales. The author was one of the authors of the Cincinnati scale and described it was never intended to be a indicator for determination of CVA, rather for epidemiology research. This exam does a mini-neuro and with the course one can learn more about the site of stroke and more assessment of SAH vs. NIS. For the full detailed assessment checklist : http://www.asls.net/forms/MEND%20Prehospital%20Checklist.pdf

Initially a modified Cincinnati is performed, it is determined then if rapid transport is needed. The MENDS is performed enroute. Each one is done in order & repeated enroute. ED's can adapt to this as well. ASLS has a course for ED's, Stroke Centers, ICU, etc..

R/r 911