Initial patient assessmentUsing F.A.S.T., Rosier, & NIHSSTools - PDF document

Initial patient assessmentUsing F.A.S.T., Rosier, & NIHSSTools 5 Acute Trusts -6 Primary Care Trusts –Ambulance Trust –4 Lo Stroke Thrombolysis Awareness Adapted from F.A.S.T.InstructionsFACIAL MOVEMENTS there an unequal smile or grimace, Lift the patient’s arms together to 90ºif sitting, 45ºif supine and ask them to hold the position for 5 seconds before letting go, does one arm driftdown or fall If one arm drifts down or falls, note whether it is the patient’s left or right Listen for NEW Listen for slurred speech, get patient to say Listen for word-finding difficulties with hesitations. This can be confirmed by •Check with any person who knows the patient, to ring 999 ROSIER 1st. Check Patient’s B.M. and correct if low YesNoHas there been loss of consciousness or syncope?-10-10+10 +10 Asymmetric leg weakness +10 Speech disturbance +10 Visual field deficit +10 •People with stroke or witnesses can usually tell •There should be no prodrome•Particular care with common differentials–Bell’s palsy–Labyrinthitis–Demyelination–Space occupying lesion–Worsening previous neurology with infection •Abnormal movements are rare after stroke•Seizure at stroke onset is rare and a •Positive visual phenomena more likely to be •Headache is rare after stroke and rarely prominent when present –consider SAH Symptoms and signs of loss of function •Seizures•Syncope (hypotension)•Sugar (hypo or hyper)•Sepsis (+ previous stroke)•Severe migraine•Space occupying lesions•Si-chological Stroke mimics So what’s the rush? •Confirm stroke or TIA is the problem•Help prevent complications•Consider emergency treatmentsE.G. Thrombolysis•Admission to a stroke unit On arrival at A&E or the stroke unit, the diagnosis of a stroke or TIAshould be checked using an accepted test such as ROSIER (Recognition of Stroke in the Emergency Room).NICE clinical guideline 68Issue date: July 2008 National Guidance •Seizures•Syncope (hypotension)•Sugar (hypo or hyper)•Sepsis•Severe migraine•Space occupying lesions•Si-chological •Onset never established for ¼patients•When the first •Not just when deteriorated later•Sleep –backdate to bedtime•Witnesses –when was last seen to be OK•Very important for–Thrombolysis potential–TIA risk stratification Why ? •Systematic neurological assessment for stroke•Quantitative measure of neurological deficit•Reliable & reproducible tool•~5 mins to complete•Score from 0 -42 NIHSSNational Institutes of Health Stroke Scale