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 paresis b. Arm drift c. Abnormal speech RECOGNITION OF STROKE IN THE EMERGENCY ROOM / ROSIER 1. Has there been loss of consciousness or temporary loss of consciousness due to a 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 the hospital 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.

SUDDEN severe headache with no known cause.

MANAGEMENT OF STROKE PHARMACOLOGIC TREATMENTS FOR PEOPLE WITH STROKE Thrombolysis with alteplase Aspirin and anticoagulant treatment All people presenting with acute stroke who have had a diagnosis of primary intracerebral haemorrhage excluded by brain imaging should, 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 after stroke. 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 oxygen only if their oxygen saturation drops below 95%. The routine use of supplemental oxygen is not recommended in people with acute stroke who are not hypoxic. BLOOD SUGAR CONTROL People with acute stroke should be treated to maintain a blood glucose concentration between 4 and 11 mmol/litre. Optimal insulin therapy, which can be achieved by the use of intravenous insulin and glucose, should be provided to all adults with diabetes who have threatened or actual myocardial infarction.

BLOOD PRESSURE CONTROL Anti-hypertensive treatment in people with acute stroke is recommended only if there is a hypertensive emergency with one or 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 over 200 mmHg.