Friday, April 15, 2016

Step 2 CS: Headache / photophobia

When dealing with a patient with severe photophobia, you might want to dim the light out for the patient just to make the patient comfortable. Say, "I see that the light is making you uncomfortable, let me dim the lights out for you to make you feel more comfortable."

Then you start taking history.

Think of differentials, then ask  about -

Migraine - Ask about aura, catamenial migraine

Cluster headache - Ask about tearing of eyes, rhinorrhea

Tension headache - Ask about stresses in life

Meningitis - Ask for neck stiffness, fever

Sinusitis - Ask for sinus tenderness

Temporal arteritis - Ask for pain on movement of joint

Intracranial lesion - Ask for headache that wakes up the patient at night

ROS - Ask for weakness / numbness / weight appetite / nausea vomiting

Skip sexual, exercise, diet in this history. Save time :)

When you dim the light in step 2 CS, it completely blacks out. You might wanna switch on the lights to examine, in which case you can tell them - I know this is uncomfortable but I need to switch the lights to examine you. Is that okay with you? Please cover your eyes and bear with me for a moment.
It's hard to write notes in the dark, be prepared for it.

What to examine:

"I'm going to press on your face, let me know if there is any pain."
*check for sinus tenderness*
"I want you to lie down for me, let me help you with the bed rest."
"I am going to lift you leg, let me know if there is any pain and I'll stop"
*Do kernigs*
"I am going to bend your neck, let me know if there is any pain."
*Do Brudzinkis*
"Let me help you sit back up"

If time permits:
Do eye movements, visual acuity.
Check ears, nose throat

If you have even more time, do Cranial nerves.

Your patient note would look like:

PATIENT IS IN SEVERE PAIN
VS - WNL

HEENT - NC/AT
NO SINUS TENDERNESS (Or you could write NON TENDER TO PALPATION)
EOMI (Do not shine light in the patient's eyes just to write PERRLA xD)
NO NASAL CONGESTION
NO TONSILLAR ENLARGEMENT, NO ERYTHEMA OR EXUDATES

NEURO - AAO X 3
CN 2-12 GROSSLY INTACT

NO NECK STIFFNESS
KERNIGS -VE
BRUDZINSKI -VE


3 comments:

  1. 1. Can you do the eye examination with lights on? With ref to -(When you dim the light in step 2 CS, it completely blacks out. You might wanna switch on the lights to examine, in which case you can tell them - I know this is uncomfortable but I need to switch the lights to examine you. Is that okay with you?

    2. What does this mean? - (Do not shine light in the patient's eyes just to write PERRLA xD)Could not understand.

    ReplyDelete
    Replies
    1. Oh I am so sorry - I just realized this post makes no sense at all.

      Lemme clarify.

      Delete
    2. 1. You can examine the patient and take the history with the lights on.
      By dimming the lights, you make the patient comfortable.

      2. You need to shine the light in a patients eye to check for the pupils and write, "PERRLA" (pupils equal, round, react to light, accommodation). Shining light in a patient who has photophobia might not be the best idea.

      I was being funnny there xD

      Delete

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