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ASSESSMENT OF STROKE

FACE-ARM-SPEECH TEST / FAST

A test that examines facial weakness, arm weakness, and speech disturbance.

Face:Has their face fallen on one side?Is the patient still capable of making facial expressions such as smiling, puffing out

cheeks, etc.?

Arms:Can they raise their both arms and keep it there?Are they still able to move their upper extremities?

Speech:Is their speech slurred?Do they have trouble in talking?

Three signs most diagnostic of stroke:a. Facial paresisb. Arm driftc. Abnormal speech

RECOGNITION OF STROKE IN THE EMERGENCY ROOM / ROSIER

1. Has there been loss of consciousness or temporary loss of consciousness due toa drop in blood pressure (syncope)? If yes score = -1, if no score = 0

2. Has there been seizure activity? If yes score = -1, if no score = 0

3. Is there a NEW onset of the following symptoms (or on waking from sleep):

Asymmetric facial weakness? If yes score = +1, if no score = 0 Asymmetric grip weakness? If yes score = +1, if no score = 0

Asymmetric arm weakness? If yes score = +1, if no score = 0

Asymmetric leg weakness? If yes score = +1, if no score = 0

Speech disturbance? If yes score = +1, if no score = 0

Visual field defect? If yes score = +1, if no score = 0

The total score will range between -2 and +6.

If the total score is between +1 and +6, then the patient should be referred to thehospital stroke team and/or admitted to the hospital stroke unit.

STROKE SYMPTOMS INCLUDE:

SUDDEN numbness or weakness of face, arm or leg - especially on one side of the

body.

SUDDEN confusion, trouble speaking or understanding.

SUDDEN trouble seeing in one or both eyes.

SUDDEN trouble walking, dizziness, loss of balance or coordination.

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SUDDEN severe headache with no known cause.

MANAGEMENT OF STROKE

PHARMACOLOGIC TREATMENTS FOR PEOPLE WITH STROKE

Thrombolysis with alteplase

Aspirin and anticoagulant treatmentAll people presenting with acute stroke who have had a diagnosisof primary intracerebral haemorrhage excluded by brain imagingshould, as soon as possible but certainly within 24 hours, be given:

aspirin 300 mg orally if they are not dysphagic or aspirin 300 mg rectally or by enteral tube if they are

dysphagic

MAINTENANCE OR RESTORATION OF HOMEOSTASIS

A key element of care for people with acute stroke is the maintenance of

cerebral blood flow and oxygenation to prevent further brain damage afterstroke. This section contains recommendations on oxygen supplementation,maintenance of normoglycaemia, and acute blood pressure manipulation.

SUPPLEMENTAL OXYGEN THERAPY

People who have had a stroke should receive supplemental oxygenonly if their oxygen saturation drops below 95%. The routine use ofsupplemental oxygen is not recommended in people with acutestroke who are not hypoxic.

BLOOD SUGAR CONTROL

People with acute stroke should be treated to maintain a bloodglucose concentration between 4 and 11 mmol/litre.

Optimal insulin therapy, which can be achieved by the use ofintravenous insulin and glucose, should be provided to all adultswith diabetes who have threatened or actual myocardial infarction.

BLOOD PRESSURE CONTROL

Anti-hypertensive treatment in people with acute stroke isrecommended only if there is a hypertensive emergency with oneor more of the following serious concomitant medical issues: hypertensive encephalopathy hypertensive nephropathy hypertensive cardiac failure/myocardial infarction aortic dissection

pre-eclampsia/eclampsia intracerebral haemorrhage with systolic blood pressure over200 mmHg.