A fictional 73-year-old suddenly develops expressive dysphasia and right arm weakness during breakfast.
Frame the danger first.
- Sudden focal neurological deficit should trigger a stroke assessment and urgent pathway activation.
- Establish the exact last-known-well time and premorbid function.
- Check glucose promptly and consider seizure, migraine and other mimics without delaying stroke assessment.
Act, escalate, reassess.
- Activate the local hyperacute stroke pathway and arrange urgent brain imaging as directed.
- Record onset/last-known-well time, neurological deficit, anticoagulant use and relevant contraindications.
- Keep the patient nil by mouth until an appropriate swallowing screen is completed.
- Seek immediate stroke-specialist decisions about reperfusion and subsequent management.
Red flags that change pace.
- Reduced consciousness, rapidly worsening deficit or airway compromise
- Posterior-circulation features with deterioration
- Severe headache, meningism or features suggesting intracranial haemorrhage
What makes care less safe.
- Missing posterior-circulation stroke because FAST is negative
- Delaying referral while completing non-essential investigations
- Giving oral food, fluid or medicines before swallow screening
Say the concern plainly.
Possible acute stroke: last known well [time], deficit [brief description], glucose [result], anticoagulation [yes/no], baseline function [summary]. The stroke pathway is active and urgent specialist assessment is required.