Stroke 🧠
Clinical guide for stroke and TIA management. FAST assessment, acute stroke protocol, thrombolysis criteria, and neurology referral for on-call doctors.
🧠 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
🕒 26 / 05 / 2026 — 12:26 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: _______