ERDoc Posted October 18, 2006 Share Posted October 18, 2006 It is 0630 and you are called to the house of a 45y/o female who was woken by a severe headache. Scene is safe, blah, blah, blah. She appologizes for calling but says that her husband just took the car and left for work. What do you want to know? Link to comment Share on other sites More sharing options...
AZCEP Posted October 18, 2006 Share Posted October 18, 2006 PMHx? What was she doing when it started? Can she localize it? Facial droop? Link to comment Share on other sites More sharing options...
hammerpcp Posted October 18, 2006 Share Posted October 18, 2006 Vitals, history, meds. Whats she look like? Link to comment Share on other sites More sharing options...
MrSpykes Posted October 18, 2006 Share Posted October 18, 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. Link to comment Share on other sites More sharing options...
brock8024 Posted October 18, 2006 Share Posted October 18, 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. Link to comment Share on other sites More sharing options...
alpha23958 Posted October 18, 2006 Share Posted October 18, 2006 Say: Why the hell couldn't you call a taxi, since you were going to drive to the ER anyway? Link to comment Share on other sites More sharing options...
becksdad Posted October 18, 2006 Share Posted October 18, 2006 I'm going to wait and see what at least a few of the answers are to some questions before I make any kind of Tx decision. Just knowing "headache" is not enough. Sure, O2 won't hurt, but if patient is aaox4 and satting @ 97-100%, its just not a priority. I definitely wouldn't administer any drugs. Depending on what is really going on, analgesics, antihistamines, anti-emetics could all be contraindicated. I'm thinking ERdoc's next post will give a little more info.... Link to comment Share on other sites More sharing options...
brock8024 Posted October 18, 2006 Share Posted October 18, 2006 If you noticed I said I would call for the meds and I would also look at that is the presentation also. As for o2, I have seen ER docs give it for headaches and it worked. o2 is not going to hurt her at all and if it helps why not.??? Link to comment Share on other sites More sharing options...
becksdad Posted October 18, 2006 Share 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. Link to comment Share on other sites More sharing options...
chaser Posted October 18, 2006 Share Posted October 18, 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? Link to comment Share on other sites More sharing options...
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