What is the management of headache in the acute setting?
Management of headache in the acute setting should focus on excluding serious secondary causes, making a positive diagnosis, managing symptoms, and establishing a continuing care plan. Clinical assessment is based primarily on the history. A focused clinical examination helps exclude serious pathology.
What is the role of the attending physician in headache assessment?
The role of the attending physician is to take a comprehensive history to diagnose and treat benign headache syndromes while ruling out sinister aetiologies. This brief article summarises the approach to assessment of headache presenting in acute and emergency care.
Which patient should be considered as a high priority for transport?
Every patient with a disturbance to the airway, breathing, or circulation or an acute change in mental status should be considered as high priority for transport. Consider ALS intercept according to local protocols. For which patient is transport in the lateral recumbent positon most appropriate? A.
What are the key points in the diagnosis of recurrent headaches?
Key Points. Recurrent headaches that began at a young age in patients with a normal examination are usually benign. Neuroimaging is recommended as soon as possible for patients with altered mental status, seizures, papilledema, focal neurologic deficits, or thunderclap headache. CSF analysis is required for patients with meningismus and usually,...
Which patient should be given a higher priority for transport?
Victims with life-threatening injuries or illness (such as head injuries, severe burns, severe bleeding, heart-attack, breathing-impaired, internal injuries) are assigned a priority 1 or "Red" Triage tag code (meaning first priority for treatment and transportation).
Which of the following should not be done with an actively seizing patient?
Do not put anything in the person's mouth. This can injure teeth or the jaw. A person having a seizure cannot swallow his or her tongue.
What is the purpose of placing an unresponsive patient in a lateral recumbent position for transport?
Putting someone in the recovery position will keep their airway clear and open. It also ensures that any vomit or fluid won't cause them to choke.
When assessing a patient for facial droop you should?
In summary, when assessing a patient with acute facial weakness: 1) Talk to the patient; 2) Examine the muscles in the upper and lower face; and 3) Look for associated signs and symptoms. If the facial weakness is isolated to the lower face, stroke is the most likely diagnosis.
How do you care for a seizing patient?
cushion their head if they're on the ground. loosen any tight clothing around their neck, such as a collar or tie, to aid breathing. turn them on to their side after their convulsions stop – read more about the recovery position. stay with them and talk to them calmly until they recover.
Which of the following would be most appropriate to do when giving care to a person having a seizure?
Stay calm and remain with the person. If they have food or fluid in their mouth, roll them onto their side immediately. Keep them safe and protect them from injury. Place something soft under their head and loosen any tight clothing.
What is the lateral recumbent position used for?
a position to facilitate a vaginal examination, with the patient lying on her side with the lower arm behind the back, the thighs flexed, the upper one more than the lower.
Why do you place a patient on the left side?
Transport to Medical Care Patients should be transported to a hospital as quickly, but as passively, as possible. They should be placed on their left side in the recovery position to prevent aspiration of vomit.
What is the meaning of recumbent position?
lying downAdjective. prone, supine, prostrate, recumbent mean lying down. prone implies a position with the front of the body turned toward the supporting surface.
How do you assess a client when the nurse suspects the onset of CVA?
Your initial evaluation of a patient with a suspected stroke should include airway, breathing, and circulation, followed by neurologic assessment using either the NIHSS or the mNIHSS, per facility policy.
When assessing a patient with a suspected stroke the order of the exam would be?
Patients with suspected acute stroke should have a rapid initial evaluation for airway, breathing and circulation [Evidence Level A]. A neurological examination should be conducted to determine focal neurological deficits and assess stroke severity [Evidence Level A].
What is facial droop?
What is facial droop? Facial droop occurs when there is damage to the nerves in the face, preventing the facial muscles from working properly. The nerve damage can either be temporary or permanent. Facial droop can also be caused by damage to the part of the brain that sends nerve signals to the facial muscles.
How successful is the prehospital stroke screen?
The prehospital stroke screen has been found to have a 97% success rate in determining which patients have actually suffered a stroke.
Why does insufficient breathing cause brain damage?
Inadequate breathing could drastically increase injury to the brain because of decreased oxygen flow to the brain and buildup of carbon dioxide. You arrive at a scene and begin to provide care to a patient who is complaining of a severe headache. You notice that you are also getting a severe headache.
Can you exercise control over the information that is sought?
A. You can exercise control over the information that is sought.
What are the most common causes of headaches?
Overall, the most common causes of headache are. Tension-type headache. Migraine. Some causes of headache are common; others are important to recognize because they are dangerous, require specific treatment, or both (see table Some Characteristics of Headache Disorders by Cause ).
What is the purpose of evaluation for headaches?
If no cause or serious symptoms are identified, evaluation focuses on diagnosing primary headache disorders.
What is the pain in the head called?
Videos (0) Headache is pain in any part of the head, including the scalp, face (including the orbitotemporal area), and interior of the head. Headache is one of the most common reasons patients seek medical attention.
What is the most common reason for a patient to seek medical attention?
Approach to the Patient With Headache. Headache is pain in any part of the head, including the scalp, face (including the orbitotemporal area), and interior of the head. Headache is one of the most common reasons patients seek medical attention.
What is neuroimaging for?
Neuroimaging is recommended as soon as possible for patients with altered mental status, seizures, papilledema, focal neurologic deficits, or thunderclap headache.
What is the scalp exam?
The scalp is examined for areas of swelling and tenderness. The ipsilateral temporal artery is palpated, and both temporomandibular joints are palpated for tenderness and crepitance while the patient opens and closes the jaw.
Why is the neck flexed?
Neck is flexed to detect discomfort, stiffness, or both, indicating meningismus. The cervical spine is palpated for tenderness.
What position to place unresponsive patient?
placing the unresponsive patient in the prone position.
When to place unresponsive patient in lateral recumbent position?
place the unresponsive patient in the lateral recumbent position if no spinal injury is suspected.
What is the phase of a seizure in which the patient has extreme muscular rigidity with hyperextension of?
The phase of a seizure in which the patient has extreme muscular rigidity with hyperextension of the back is known as the: Hypertonic phase . The patient with a history of seizures may experience an unusual sensation that precedes a seizure episode by a period of time. This sensation is known as a/an:
What is the treatment for epilepsy?
Medications commonly used in the treatment of epilepsy include: Phenobarbital.
What happens when you have muscle contractions during a seizure?
Some muscle contractions during a seizure are so severe that a bone injury or dislocation may result.
Is a patent seizure normal?
You are treating a known epileptic, who is in her second trimester of pregnancy, for a generalized seizure. Your patent's seizure is normal for her condition, and on your arrival, she is postictal, regaining consciousness, and reluctant to be transported.
Do epileptic patients need emergency care?
The epileptic patient does not necessarily want or need emergency care after a seizure.
Can a complex partial seizure be mistaken for a (n)?
Simple partial. It is important that the EMT recognize that a complex partial (psychomotor) seizure can easily be mistaken for a (n): Alcohol intoxication. A female patient with a history of seizures has suffered a seizure in a public area and is now refusing further assessment and transport.
What is the best way to manage headaches?
Management of headache in the acute setting should focus on excluding serious secondary causes , making a positive diagnosis, managing symptoms, and establishing a continuing care plan. Clinical assessment is based primarily on the history. A focused clinical examination helps exclude serious pathology. Investigations should be requested only where necessary. Imaging is not a substitute for robust clinical assessment.
What are the triggers for migraines?
Eg stress, menstruation, diet, caffeine, alcohol, dehydration and other triggers are associated with migraine
What is side locked headache?
Strictly unilateral ‘side-locked’ headaches are characteristic of cluster headache and related disorders (trigeminal autonomic cephalalgias) but can also occur in migraine
How long does it take for a headache to peak?
Possibly the most useful question. ‘Sudden onset’ is not sufficiently specific; ‘thunderclap’ headache should peak within 1 minute (at most 5 minutes); cluster headache develops over up to 30 minutes; migraine develops over hours
What is the most common neurological symptom?
Headache is the commonest neurological symptom. 1–4% of emergency department (ED) attendances are due to headache, although only a small minority of these have a serious cause such as intracranial haemorrhage or meningitis.1,2
How long does migraine last?
Migraine and many secondary headaches are present from hours to days; headaches lasting minutes or those present for months or years tend to be more benign
What should be considered in a neurological exam?
Examination should particularly assess for disturbance of vital signs, meningism, altered consciousness and obvious focal neurological deficit. Take particular care over ocular examination for ophthalmoplegia, ptosis, pupillary abnormalities and fundoscopy looking for papilloedema which are easily missed and may reflect serious pathology.
What is an unconscious state in which the patient does not respond to painful stimuli?
Altered mental status. An unconscious state in which the patient does not respond to painful stimuli is referred to as: A coma . When a driver is pulled over and asked to walk a line by the police officer this is an attempt to assess for: Ataxia.
When to place unresponsive patient in lateral recumbent position?
Place the unresponsive patient in the lateral recumbent position if no spinal injury is suspected.
Why is it important to have a simple mechanical airway?
Because hypoxia is a cause of altered mental status. When managing a patient that you have decided has an AVPU of "U" it will be important to: Place a simple mechanical airway. You are reassessing your unconscious patient and have determined that his respirations are no longer of an adequate depth.