A 24 year old female presents to the ED complaining of a worsening headache after a lumbar puncture performed in the ED 2 days prior which diagnosed idiopathic intracranial hypertension. "No problem!" you think. Either this is just a post LP headache or possibly the patient needs more CSF drained to improve her headache. LP is a very safe procedure with minimal risk after all! Right?
Most patients presenting to the ED with a headache have a simple primary headache: tension, migraine, or cluster. Detecting the "other" etiolgies for headache, which can result in neurologic devastation or death, is often a diagnostic challenge. He we give some quick hits for one of the "can't miss" headaches, how it presents, and how to diagnose it.
A 55 year old male presents to the ED with complaints of anterior chest pain radiating through to the thoracic area X 2 days...you mentally run through a check list of the potential "red flag" signs/symptoms for serious back pain before you enter the room. Will this be another benign musculoskeletal pain or something more sinister?
A 50 yo male is brought in via EMS vomiting red fluid. 1 hour prior, he had chugged about half a gatorade bottle that he had used to store windshield washer fluid. "What's in windshield washer fluid?" you wonder as you enter the patient's room. "Is it bad????" Read on to find out why, yes, this is very bad indeed.
11-year-old boy previously health who presents with testicular pain. He had sudden onset of pain that started 6 hours ago. He rates it 8/10, states it has been constant since then and is non-radiating. He denies dysuria and similar pain in the past. He further denies testicular trauma and recent fevers. He had one episode of emesis while in the waiting room.
A 59 year old male presents complaining of unsteadiness on his feet and vomiting for 24 hours. You know there are numerous benign explanations for his symptoms, but also realize there are a few "can't miss" diagnoses as well...what are they and how do we assess for them in the ED?
A 23 yo male with a hx of insulin dependent diabetes and recurrent admissions for DKA presents to the ED with complaints of diffuse body aches. He is acutely ill appearing, agitated, and combative with staff, demanding pain medication, entering other patients rooms, and screaming. Realizing that this patient is severely ill, you wonder how you will de-escalate or sedate this patient safely to enable life-saving care to be rendered.....