[Music]
Facilitator 2 (FA2): Okay, let's go back and watch some more video cases here.
[Patient, sitting in a chair, clutching her head with her eyes closed...moans...]
Patient (P): I have an awful headache.
I can't stand the pain. I've had headaches before, but not like this one.
Nurse (N): You look really miserable. You know on a scale of 0 to 10, if 10 was the
worst pain you could ever imagine, how would you rate it right now?
P: A 10+ - I can't stand it.
N: when did this start?
P: Today, about an hour ago. I went to
the bathroom. I moved my bowels and it started right after that.
N: Okay. Are you having any nausea or vomiting?
P: I feel sick to my stomach. Can't you give me something for the pain?
N: No, not right now. You're going to see the doctor in a few
minutes, so first I need to ask you a couple more questions and get your blood
pressure, okay? How old are you?
P: 35 N: Okay.
N: And do you have any medical problems? P: No.
N: Do you take any medications everyday for any reason?
P: No. N: Okay, and do you have
any allergies to medications? P: No.
N: Okay.
[Music]
Facilitator 1 (FA1): This is an ESI level 2. This patient has a new onset severe headache that is a
typical presentation for a subarachnoid hemorrhage. This is a high-risk situation.
Headaches are frequent complaints and are worthy of a little further
discussion. Patients that present with their typical migraine headache are
often triaged as ESI Level 3. They usually require an IV with fluid and IV pain
medication. However, migraine patients that know they
only require an IM selective serotonin agonist (Imitrex), an anti migraine medicine, will
require only 1 resource, an IM medication and therefore will be
classified as ESI Level 4. Even a patient with a typical migraine that presents in
severe pain, vomiting at triage, even though it is a typical headache could be
triaged as ESI Level 2 due to severe pain. To summarize, with headaches history
is important to rule out a high-risk situation. Then you really need to assess
how the patient looks and finally how many resources you might anticipate will
be needed. In this particular scenario, the patient met ESI Level 2 criteria.
FA2: Okay, so headaches are kind of messy and grey sometimes.
So, what do you guys think about that scenario?
Registered Nurse 2 (RN2): Well, I think that scenario opened my eyes to
how I treat headaches and especially people with migraines. Because you didn't
think, well, you know it's just a headache so you don't really think much about the
bleeding or like a possible tumor or something. But I do agree with that level
that she should be a 2, because of her, I think, the reason why that was a
2 mainly because of her pain and her instability. Am I correct?
Registered Nurse 1 (RN1): I think the connection with the bowel movement was really important too.
And she looked so awful too. RN2: Yeah, she did.
RN1: Although some migraine people do, but the bowel
movement connection was important, I think.
FA1: Definitely that [bellos a very]
heavy bowel movement was certainly a tip-off that this could be a subarachnoid creator. Good.
FA2: That's what put her over edge. Any other headache kind of questions?
RN1: No. Just the "worst headache I've
ever had in my life" - do you up the acuity for that statement?
FA2: "Worst headache of their life" - usually once they say that, it's pretty tough to
not make them a Level 2 patient.
RN1: Even in a migraine person who has
frequent migraines?
FA2: It's their worst migraine and worse than their normal
grand migraine and it's not typical migraine, then I probably would.
FA1: I would too. Absolutely.
RN1: Although, they sometimes say that because they want pain medication fast, I think.
Registered Nurse 3 (RN3): Well, you have to take them at their word when you're triaging them.
FA1: Exactly. RN1: Sure. Okay.