FAST

There was a patient who fell at home. Admitted to telemetry for syncope, which is a usual type of admission. Up and about, talking to family, walking to the bathroom, usual activities. Around shift change out on the floor, the nurses call the rapid response team. Pt has had a significant neuro status change. The pt is reassessed and md called. Pt is transferred immediately to the ICU.

Upon arrival, we all go in the room to assist with the admission. Primary nurse is assessing while the other nurse and I get the patient hooked up, vs, etc. At this time, the patient is barely responsive, has significant left sided weakness, and is having difficulty with secretions. Prominent facial droop to the left side. BP is 200s/100s. HR tachycardic with bursts of svt and vtach. Full code. Nurse calls the md and tells him to get in here now. You see the pt was a prominent VIP around town and the admitting md knows the patient personally.

As soon as the doc arrives, we assist him in performing an elective intubation. Amiodarone is given which stops the vtach episodes. The patient is sent downstairs for a stat CT. Doc is on the phone with trauma center attempting to find placement so we could get this patient shipped out. Until the films are done.

There would be no shipping this patient anywhere. The patient had a fatal hemorrhage that displaced almost the entire right side of the brain, and the only thing keeping them alive at this time was the ventilator and medications. Posturing is evident. Seizing is evident. The spouse wants to wait for the all of the children to come in to say goodbye. And so we oblige their wishes. The next day, the patient finally passes 15 minutes after being taken off of life support.

Not all stroke outcomes are such as this. A couple of important details that aren't in the story: Admitting CT showed absolutely no sign of hemorrhage. Secondly, the patient was on Coumadin, which probably contributed to the massive size of the bleed.

It is important for us as medical personel to remember the quick assessment for a stroke: FAST.
F: Face
A: Arms
S: Speech
T: Time.

Never underestimate the significance of your neuro checks.