18. Headache - ABC

Question 1

Problem Suffixes (When stroke diagnostic tool is completed, its recommendation is paired w/ time frame of symptom onset)

Answer 1

COMPLETED Stroke Diagnostic Tool
C: PARTIAL evidence (Less than “T” hours)
D: PARTIAL evidence (Greater than “T” hours)
E: PARTIAL evidence (Unknown time frame)

F: STRONG evidence (Less than “T” hours)
H: STRONG evidence (Greater than “T” hours)
I: STRONG evidence (Unknown time frame)

J: CLEAR evidence (Less than “T” hours)
K: CLEAR evidence (Greater than “T” hours)
M: CLEAR evidence (Unknown time frame)

X: No test evidence (Less than “T” hours)
Y: No test evidence (Greater than “T” hours)
Z: No test evidence (Unknown time frame)

NOT COMPLETED/NOT USED Tool
L: Less than “T” hours
G: Greater than “T” hours
U: Unknown

Question 2

STROKE Treatment Time Window

Answer 2

Time of symptom onset is determined in KQs. Hospital and/or responder notification of this finding plays important part in preparing patient’s therapy. The suffix codes for STROKE include a locally defined treatment time window. “T” = Time window set by local Medical Control

Question 3

Rule 1

Answer 3

Sudden onset of severe headache is considered to have more serious underlying cause until proven otherwise

Question 4

Rule 2

Answer 4

STROKE must receive an immediate response that is not subject to delay. Lights-and-siren are not recommended; however, there should be a sense of urgency

Question 5

Axiom 1

Answer 5

The most important objecting of this protocol is to determine if the underlying cause of headache might be life-threatening but potentially treatable condition such as STROKE, meningitis, or other serious brain condition. Headache, in and of itself, is not a diagnosis but very general symptom of many other low-acuity problems.

Question 6

Axiom 2

Answer 6

Headaches that are both sudden and severe, especially when associated with speech or movement problems (numbness or paralysis) may represent the early onset of a serious condition

Question 7

Axiom 3

Answer 7

Some younger people have STROKES (often fatal) from a ballooned blood vessel called a berry aneurysm that expands and then breaks. This condition is present from birth (congenital). Early symptoms include a sudden, severe headache.

Question 8

Axiom 4

Answer 8

Patients who call an ambulance for a headache generally have a more serious underlying cause than patients who arrive at the EMRG department on their own

Question 9

Axiom 5

Answer 9

Stroke Diagnostic Tool enables EMDs to notify stroke centers early in an effort to decrease the time from symptom onset to definitive treatment. The dispatcher’s report of Stroke Diagnostic Tool results, symptom onset time, and witnessing persons’ contact information helps hospitals prepare and improves patient outcomes

Question 10

Stroke Symptoms (Select Protocol 28 for conscious and breathing patient when caller initially reports “stroke” or sudden onset of one or more of the following symptoms):

Answer 10

• Sudden speech problems
• Sudden weakness, numbness, or paralysis of face, arm, or leg on one side of body
• Sudden loss of balance or coordination
• Sudden trouble seeing in one or both eyes
• Sudden, severe headache with no known cause

Question 11

Serious Types and Causes

Answer 11

• Berry aneurysm rupture (ballooned blood vessel that breaks)
• Epidural hematoma (blood clot around brain)
• Intracerebral hemorrhage (bleeding within brain)
• Ischemic infarction (thromboembolic storke)
• Subarachnoid hemorrhage (bleeding around brain)
• Subdural hematoma (blood clot around brain)

Question 12

Possibly Serious Types and Causes

Answer 12

• Hypertension
• Meningitis
• Post-traumatic (hit head)

Question 13

Not Serious Types and Causes

Answer 13

• Cluster
• Migrain
• Sinus
• Tension