Focused Assessments

Question 1

What does PILSDUCT stand for and what is it used for?

Answer 1

Fracture assessment:

P- Pain
I- Irregularity
L- Loss of function 
S- Swelling
D- Deformity
U- Unnatural movement
C- Crepitus 
T- Tenderness

Question 2

MASS stroke assessment

Answer 2

Facial droop
Arms - grip strength
Speech - slurring or unable to speak
B- Assess BSL

Question 3

RASH Criteria

Answer 3

If 2 or more are present in the setting of sudden onset symptoms ( <30 mins or up to 4 hrs), suspect anaphylaxis regardless of exposure:
R- respiratory distress
A- abdominal symptoms
S- skin/mucosal symptoms
H- Hypotension 

OR suspect anaphylaxis if exposure to a known trigger and:

• Isolated hypotension (BP<90) or
• Isolated resp distress

Question 4

SIRS Criteria

Answer 4

In presence of infection, where two or more of the following are present:

Temp >38 or <36
HR >90
BP <90
RR >20

Question 5

What is 5HEDS and when is it used?

Answer 5

To determine a “serious blunt head injury”
5- LOC exceeding 5 minutes
H- Head injury (fracture)
E- Emesis more than once (could mean increased ICP)
D- Deficit - any neuro deficit
S- Seizure of any duration

Question 6

AEIOUTIPS

Answer 6

Alternative causes of altered conscious states: 
A- Alcohol/drugs
E- Epilepsy 
I- Insulin 
O- Overdose or Oxygen 
U- Underdose (medication/withdrawal)
T- Trauma 
I- Infection
P- Pain or psychiatric condition
S- Stroke/TIA

Question 7

NEXUS

Answer 7

Used where there is a MOI with potential to cause SCI, and pt does not meet major trauma criteria or have neuro deficits.
SPINAL Hx

S- significant distracting injury
P- Pain/tenderness to midline
I- Intoxication
N- Neurological deficit
A- Age 65 and over or Altered conscious state
L- loss of function/ROM (pt unable to rotate neck 45 degrees without pain)
H- Hx of bone/muscle disease

Question 8

Neurovascular Assessment

Answer 8

• Distal pulse
• Cap refil
• Warmth
• Movement
• Colour

Question 9

Stroke Mimics

Answer 9

MISS Molly Brown Hates MESS

M- Migraine
I- Intoxication
S- Seizure
S- Sepsis

M- Middle ear disorder (vertigo)
B- Brain tumour
H- Hypo/hyperglycaemia

M- Multiple Sclerosis
E- Electrolyte disturbance
S- Syncope
S- Subdural haematoma

Question 10

ACT FAST

Answer 10

Assessment for clot retrieval eligibility:

1. Lift pts arms and ask to hold steady. Does just one drop?
   Right > Proceed to CHAT test
   Left > proceed to TAP test

CHAT > does pt have obvious speech deficit?
If yes, and pt meets inclusion criteria = act fast positive

TAP > Stand to left (affected) side of pt and tap shoulder. If pt gaze obviously deviating to unaffected side?
If yes, and pt meets inclusion criteria = act fast positive

If no to any = ACT FAST negative - continue with routine stroke mx

Question 11

ACT FAST inclusion criteria

Answer 11

• Deficits are new or significantly worse
• Onset of symptoms <24hrs
• Lives at home independently or with minor assistance
• No evidence of stroke mimics:
  - pt is not comatose/near comatose
  - No seizure preceding symptoms
  - BSL >2.8
  - No known/active malignant brain CA