I-HUMAN CASE STUDY FOR A 34 YEARS
OLD FEMALE SARAH JOHNSON WITH
Worst headache of my life — WEEK 10
FOR WALDEN UNIVERSITY LOCATION
:OUTPATIENT CLINIC WITH X-RAY, ECG,
AND LABORATORY CAPABILITIES FULL
CASE STUDY WITH A SOAP NOTE
,SARAH JOHNSON, 34F
Chief Complaint: "Worst headache of my life"
HISTORY OF PRESENT ILLNESS (HPI)
Identification:
• Patient: 34-year-old female
• Informants: Patient (reliable though in pain) and husband (critical
collateral)
• Setting: Emergency Department, acute presentation
OLDCARTS Analysis:
O - Onset: "Thunderclap" - Sudden, instantaneous, maximal intensity at
onset. Precise timing: 20:30 (85 minutes ago) while lifting her 8-week-
old infant (approximately 20 lbs) into the crib. Husband reports she
"screamed and collapsed."
L - Location: Occipital (back of head) with radiation to neck, shoulders,
and bilaterally behind eyes.
D - Duration: Constant, unrelenting for 85 minutes.
C - Characteristics:
• Quality: "Like being hit in the back of the head with a baseball bat"
or "a sudden explosion."
• Severity: 10/10. The "absolute worst pain imaginable." Worse than
any previous pain.
• Associated Symptoms (CRITICAL):
, 1. Transient Loss of Consciousness (LOC): Approximately 30
seconds immediately after onset (per husband).
2. Photophobia: Severe. Wearing sunglasses indoors.
Describes light as "feeling like knives."
3. Phonophobia: Moderate. Bothered by ambient ED noise.
4. Nausea: Present. Two episodes of dry heaving, no vomiting.
5. Visual Disturbance: At onset, saw "sparkles" or "stars" in her
peripheral vision.
6. Focal Neurological Symptom: "Left arm feels heavy and
clumsy."
7. Meningismus: Reports inability to touch chin to chest due to
pain/stiffness.
A - Aggravating/Alleviating Factors:
• Aggravated by: Light, noise, movement (especially neck flexion),
Valsalva maneuvers.
• Alleviated by: Lying still in a dark, quiet room. No medication has
been tried.
R - Radiation: As above. From occiput to neck, shoulders, and
retro-orbitally.
T - Temporal Pattern/Timing: Instantaneous peak with a plateau.
No fluctuation or pulsation. No prior similar episodes.
S - Setting/Context: Occurred during a Valsalva maneuver (lifting).
Patient is 8 weeks postpartum, recently started oral
contraceptives, and is a social smoker.
Red Flag Checklist (All Positive):
• [✓] Sudden, severe onset ("thunderclap")
• [✓] "Worst headache of life"
• [✓] Onset with exertion/Valsalva
• [✓] New focal neurological deficit (left arm weakness)
• [✓] Altered mental status (transient LOC)
• [✓] Meningeal signs (neck stiffness)
OLD FEMALE SARAH JOHNSON WITH
Worst headache of my life — WEEK 10
FOR WALDEN UNIVERSITY LOCATION
:OUTPATIENT CLINIC WITH X-RAY, ECG,
AND LABORATORY CAPABILITIES FULL
CASE STUDY WITH A SOAP NOTE
,SARAH JOHNSON, 34F
Chief Complaint: "Worst headache of my life"
HISTORY OF PRESENT ILLNESS (HPI)
Identification:
• Patient: 34-year-old female
• Informants: Patient (reliable though in pain) and husband (critical
collateral)
• Setting: Emergency Department, acute presentation
OLDCARTS Analysis:
O - Onset: "Thunderclap" - Sudden, instantaneous, maximal intensity at
onset. Precise timing: 20:30 (85 minutes ago) while lifting her 8-week-
old infant (approximately 20 lbs) into the crib. Husband reports she
"screamed and collapsed."
L - Location: Occipital (back of head) with radiation to neck, shoulders,
and bilaterally behind eyes.
D - Duration: Constant, unrelenting for 85 minutes.
C - Characteristics:
• Quality: "Like being hit in the back of the head with a baseball bat"
or "a sudden explosion."
• Severity: 10/10. The "absolute worst pain imaginable." Worse than
any previous pain.
• Associated Symptoms (CRITICAL):
, 1. Transient Loss of Consciousness (LOC): Approximately 30
seconds immediately after onset (per husband).
2. Photophobia: Severe. Wearing sunglasses indoors.
Describes light as "feeling like knives."
3. Phonophobia: Moderate. Bothered by ambient ED noise.
4. Nausea: Present. Two episodes of dry heaving, no vomiting.
5. Visual Disturbance: At onset, saw "sparkles" or "stars" in her
peripheral vision.
6. Focal Neurological Symptom: "Left arm feels heavy and
clumsy."
7. Meningismus: Reports inability to touch chin to chest due to
pain/stiffness.
A - Aggravating/Alleviating Factors:
• Aggravated by: Light, noise, movement (especially neck flexion),
Valsalva maneuvers.
• Alleviated by: Lying still in a dark, quiet room. No medication has
been tried.
R - Radiation: As above. From occiput to neck, shoulders, and
retro-orbitally.
T - Temporal Pattern/Timing: Instantaneous peak with a plateau.
No fluctuation or pulsation. No prior similar episodes.
S - Setting/Context: Occurred during a Valsalva maneuver (lifting).
Patient is 8 weeks postpartum, recently started oral
contraceptives, and is a social smoker.
Red Flag Checklist (All Positive):
• [✓] Sudden, severe onset ("thunderclap")
• [✓] "Worst headache of life"
• [✓] Onset with exertion/Valsalva
• [✓] New focal neurological deficit (left arm weakness)
• [✓] Altered mental status (transient LOC)
• [✓] Meningeal signs (neck stiffness)
