What advice for staff member with headache, vomiting, pyrexia, and hypertension?

Management of Staff Member with Headache, Vomiting, Pyrexia, and Hypertension

Staff members presenting with headache, vomiting, pyrexia, and hypertension should be immediately evaluated for hypertensive emergency with potential neurological complications and referred to emergency medical services for urgent care.

Initial Assessment and Triage

The combination of symptoms suggests a potentially serious condition requiring immediate attention:

• Vital signs to check:

  • Blood pressure (severe elevation >180/120 mmHg suggests hypertensive crisis)
  • Temperature (pyrexia)
  • Heart rate and respiratory rate

• Neurological assessment:

  • Level of consciousness
  • Focal neurological deficits
  • Neck stiffness
  • Photophobia

Differential Diagnosis

This constellation of symptoms raises concern for several serious conditions:

1. Hypertensive emergency - Severe BP elevation with evidence of end-organ damage 1
2. Intracranial hemorrhage - Particularly concerning with sudden severe headache and hypertension 1
3. Meningitis/encephalitis - Headache, fever, and altered mental status
4. Severe migraine with autonomic symptoms - Less likely with significant hypertension 1
5. Heat stroke/heat exhaustion - Relevant if exposure to high environmental temperatures 1

Immediate Management

For Employee Health Nurse

1. Activate emergency response:

   • Call emergency medical services (EMS) immediately for transport to nearest emergency department
   • Do not delay transport while waiting for complete assessment 1

2. While awaiting EMS:

   • Position patient with head elevated if conscious
   • Monitor vital signs continuously
   • Ensure airway is protected if level of consciousness is decreased
   • Do not administer any antihypertensive medications without medical direction 1

3. Documentation:

   • Record time of symptom onset
   • Document all vital signs
   • Note any medications the staff member is taking
   • Document any recent illnesses or exposures

Instructions for Staff

What to Tell Other Staff Members

1. Maintain calm and provide privacy:

   • Clear the immediate area
   • Assign one person to stay with the affected staff member
   • Designate another to meet EMS and direct them to the location

2. Avoid inappropriate interventions:

   • Do not give food or drink
   • Do not administer any medications without medical direction
   • Do not suggest the staff member "wait it out" or "go home to rest"
   • Short-acting nifedipine is no longer considered acceptable for hypertensive emergencies 1

3. Educational points for staff:

   • These symptoms represent a potential medical emergency
   • Hypertensive emergencies require immediate BP reduction to prevent target organ damage 1
   • Early triage and appropriate treatment are critical to limiting morbidity and mortality

Follow-up Actions

1. After the staff member has been transported:

   • Contact their emergency contact person
   • Prepare incident documentation
   • Follow up with the hospital regarding their status (as appropriate within privacy guidelines)

2. For staff member upon return to work:

   • Ensure medical clearance before resuming duties
   • Consider gradual return-to-work plan if needed
   • Monitor for recurrent symptoms

Key Points to Remember

• Headache with vomiting, fever, and hypertension should be treated as a medical emergency until proven otherwise
• The combination of these symptoms raises concern for intracranial pathology
• Rapid assessment and transfer to an emergency department is the priority
• Do not attempt to normalize blood pressure rapidly outside of a medical setting, as excessive falls in pressure may precipitate renal, cerebral, or coronary ischemia 1
• Early intervention can significantly reduce morbidity and mortality in hypertensive emergencies