Stroke Flashcards
Signs and symptoms of a stroke?
SUDDEN ONSET:
• Focal neurological deficits: Numbness or weakness of the face, arm, or leg, especially on one side of the body.
• Confusion, speech difficulties, difficulty swallowing.
• Visual disturbances.
• Trouble walking, changes in gait, loss of balance/coordination.
• Severe headache- blinding pain/ photophobia.
• Dizziness, nausea or vomiting (AVVV).
• Altered consciousness.
• Focal seizures.
• Locked-in syndrome.
• Neck pain/stiffness.
How would you assess for a suspected stroke?
ASSESSMENT (TIME CRITICAL!!):
Danger
GOCAT
Consent
Airway- foreign objects, obstruction, positioning
Breathing- Noisy breathing, respiratory rate. SpO2- if <93, administer oxygen.
Circulation- Check BM, often hypoglycaemia can be mistaken for a stroke. BP- give fluids if necessary. 3 Lead ECG but 12 lead been shown to slow down transport.
Disability- FAST test (ask patient to smile/ show teeth, look for new lack of symmetry. Ask patients to lift arms and hold, push/ pull. Ask pt to repeat a phrase, assess for slurring or difficulty, hesitation, inability to speak), NOTE TIME OF ONSET IF KNOWN, pass this info to hospital for CT scan. AVVV. Assess GCS BOTH sides of face.
Examine- temperature, pupils
History-
Presenting complaint- symptoms, onset, severity, pain, Socrates.
• Pmhx-
• Heart disease, hypertension, AF, high cholesterol, diabetes, previous stroke/ TIA, smoking, alcohol intake, sickle cell anaemia, family history of stroke, contraceptive pill?
How would you manage a suspected stroke?
Reassure, explain process, position for comfort.
URGENT transfer to HYPER ACUTE STROKE UNIT or a thrombectomy-capable hospital, pre-alert, speak to a stroke nurse.
Continue patient management en-route.
If sats 93 or below, administer oxygen to maintain SpO2 above 94% (titrate to effect.)
Give fluids If BP below 90. Gain IV access but do not delay transportation.
Pain? Paracetamol IV. 1g in 100ml.
Remain nil by mouth. Witness recommended. Minimise time on scene.
Immediately refer for specialist assessment and investigation, must be seen within 24 hours. Follow local pathways.
