Stroke 🧠

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🧠 Definition

  • Stroke = sudden loss of neurological function due to vascular cause.
  • TIA = transient deficit resolving within 24h (often <1h), no infarct on imaging.

📞 What to Ask / Orders to Make

  • Time of symptom onset / last seen well?
  • What were the symptoms? Ongoing or resolved?
  • Facial droop, arm weakness, speech changes?
  • Collateral from nursing staff / family if altered consciousness
  • Request urgent CT brain ± CT angio (per local stroke protocol)
  • Notify stroke team / med reg if within thrombolysis window (<4.5h)

🧾 History

  • Time of onset or last known well?
  • Nature of symptoms (e.g. one-sided weakness, speech, vision)?
  • Any seizure activity, headache, or trauma?
  • Risk factors: HTN, AF, diabetes, smoking, vascular history
  • Previous similar episodes or strokes?
  • Any anticoagulation or bleeding risk?

🩺 Examination

  • ABC, GCS, and vitals including glucose
  • Perform FAST exam and brief neuro screen
  • Look for asymmetry, neglect, dysarthria, visual field loss
  • Assess coordination, sensation if time permits

🔍 Investigations

  • Capillary glucose (exclude hypoglycaemia)
  • Urgent non-contrast CT brain ± angio if thrombolysis/thrombectomy candidate
  • ECG (AF?), bloods: FBC, U&E, INR/PTT, glucose, CRP
  • Consider troponin if ACS concern

💊 Initial Management

  • 🔹 Call Stroke / Med Reg ASAP if stroke suspected
  • 🔹 Nil by mouth until swallow screen
  • 🔹 If within 4.5h window: thrombolysis pathway?
  • 🔹 Outside thrombolysis window:
  • • Aspirin 300mg PO/PR stat (once haemorrhage excluded)
  • • BP permissive up to 180/100 unless thrombolysing
  • 🔹 Monitor vitals, neuro obs, and glucose closely

📋 Notes

  • Document time last seen well
  • Clearly note any witnessed deficits
  • Note if patient is anticoagulated or on antiplatelet
  • CTB result + plan from stroke/med reg

Note Template

Ready-to-use clinical note structure

🕒 20 / 11 / 2025 — 22:39

ATRP re: query stroke / focal neurology
Patient: [age] [sex]
Admission Dx: [reason for admission]
PMHx: [HTN, AF, TIA/stroke, DM, anticoagulation]

🧾 Hx:
• Time of onset: [exact / last seen well __:__]
• Deficits: [weakness / speech / vision / facial droop]
• Symptoms ongoing or resolved?
• No seizure, trauma, headache
• Collateral: [yes/no] from [nurse/family]

🩺 Exam:
• GCS: __  Vitals: HR __ BP __ Temp __ SpO₂ __ Glucose __
• FAST: [face / arm / speech]
• Focal signs: [weakness, visual field, coordination, neglect]
• Cardiovascular + ECG (AF?)

📋 Impression:
Likely [CVA / TIA / mimic]. Within thrombolysis window: [yes/no]

📌 Plan:
• Urgent CT brain ± angio
• NBM pending swallow screen
• Notify stroke/med reg
• If no bleed: aspirin 300mg PO/PR
• BP permissive < 180/100 unless thrombolysing

👤 [Your Name], [Role]
IMC: _______
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