A patient with suspected stroke arrives in the emergency room (ER). After assessing and stabilizing the patient’s ABCs (Airway, Breathing and Circulation), a focused neurological assessment is carried out. Tools include the simple Face – Arm – Speech Test (FAST), which looks for normal or abnormal facial droop ; arm drift and speech patterns. A patient’s risk factors – both modifiable and unmodifiable – will also provide valuable information.
Diagnostic testing (CT scans, MRI, cerebral angiography…) will determine whether the stroke is ischemic
« Hemorrhagic strokes occur when a cerebral vessel ruptures and bleeds within the brain. They are classified ’ as either intracerebral or subarachnoid. Intracerebral hemorrhages occur as a result of ruptured aneurysms, arteriovenous malformations, coagulopathies, tumors, cocaine abuse, anticoagulant therapy, and damage to small intracerebral arteries from chronic hypertension. A subarachnoid stroke occurs in the area between the brain and tissue that covers it. Aneurysms located at the base of the brain are the primary cause of subarachnoid hemorrhage.
If the patient is conscious, the primary presenting symptom is a severe sudden headache, which may be accompanied by focal neurological deficits, neck pain and light intolerance. In an unconscious patient, the practitioner should look for vomiting and seizure. »
1– Voir Infirmière Magazine n°.303, page 45, « Ischemic strokes ».
2– The American Journal of Nursing, May 2011 – Volume 111 – Issue 5 – p. 69 « Emergency Stroke Recognition and Management ». Auteurs : Linda K. Cook et Sheryl L. Clements.
To carry out (v)
Speech patterns (n)
Structure du langage ; du discours
Neck pain (n)
Douleur dans la nuque ; torticolis
ici, convulsions ; crise ; attaque
1. What is an ER nurse’s priority when a potential stroke patient arrives at hospital ?
Checking and stabilizing the patient’s ABCs (Airway, Breathing and Circulation).
2. Which modifiable risk factors might increase stroke risk ?
Factors include drug abuse, anticoagulant therapy and chronic hypertension. Others include obesity.
3. Can you think of other conditions that might present as stroke symptoms ?
Conditions include hypertensive encephalopathy, hypoglycemia, seizure, complicated migraines…