E5: Assessment (TIA)

Immediate referral for appropriately urgent specialist assessment and investigation is considered in all patients presenting with a TIA or minor stroke. (Key: e = element | k = knowledge | s = skill)

Knowledge and understanding of…

e5k_1:
Anatomy and physiology of the central nervous system
e5k_2:
Risk factors for stroke and TIA (e.g. lifestyle, socioeconomic, cultural, vascular, familial, genetic, concurrent medications, comorbidities)
e5k_3:
The signs and symptoms of TIA
e5k_4:
How to distinguish between stroke and TIA
e5k_5:
The future risk of stroke and TIA (e.g. ABCD2 and other risk scoring methods)
e5k_6:
The features of atypical presentation of TIA/stroke and mimics and how to act when they are identified
e5k_7:
Investigations, interventions and treatments for TIA (e.g. imaging, vascular, medical, cardiac, surgical)
e5k_8:
Implications of the Mental Capacity Act and how it applies to TIA
e5k_9:
Advocates for stroke and TIA patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations
e5k_10:
The timeframe for emergency and follow-on investigations, interventions and treatments for TIA
e5k_11:
How to initiate emergency and ongoing treatment for TIA and vascular prevention
e5k_12:
The indications, contraindications and limitations for imaging, investigations and interventions
e5k_13:
Local protocols for imaging and reporting
e5k_14:
Any complications of surgical procedures (e.g. stenting, carotid endarterectomy, closure of atrial septal defect (ASD) and patent foramen ovale (PFO))
e5k_15:
The results of investigations
e5k_16:
The implications of TIA for lifestyle, driving, work and family
e5k_17:
Management options for TIA/stroke and mimics, and other conditions

Skills and ability to...

e5s_1:
Take and interpret thorough history, record third party information where possible, and assess mental capacity
e5s_2:
Determine, plan and initiate appropriate assessments/investigations and interventions/treatments; provide information, relevant to individual needs and aspirations (personalise information)
e5s_3:
Identify risk factors and apply vascular risk assessment tools for TIA (ABCD2) and screening tests for stroke (FAST)
e5s_4:
Identify stroke, high risk TIA, lower risk TIA, atypical stroke and stroke mimics
e5s_5:
Establish the cause of TIA
e5s_6:
Recognise patients who have had a stroke rather than a TIA and to refer on for appropriate investigation and management
e5s_7:
Communicate and discuss: current event; risk of future vascular event; need for assessments/investigations, interventions/ treatments and their timeframes; rationale for treatment and possible side effects of treatment; and provide timely information, advice and support
e5s_8:
Identify emergency interventions and treatments for TIA available locally and know how to refer patients efficiently
e5s_9:
Identify the service(s) to which the individual should be referred and to liaise effectively with those services
e5s_10:
Perform a physiological assessment and assess vital signs
e5s_11:
Decide on a relevant investigation and its level of urgency
e5s_12:
Apply radiological knowledge for recognised investigations
e5s_13:
Apply technical knowledge for recognised investigations and interventions
e5s_14:
Apply surgical knowledge for recognised vascular interventions
e5s_15:
Recognise and manage postoperative complications after stenting, endarterectomy, PFO and ASD closure
e5s_16:
Obtain and interpret the results of investigations: this includes formulating an immediate and ongoing management plan, and initiating treatments within the relevant timelines
e5s_17:
Confirm and communicate diagnosis, lifestyle advice and methods of secondary prevention to patients and carers
e5s_18:
Communicate and discuss with the patient, carer, and health and social care professionals a diagnosis, results of investigations and subsequent needs and aspirations and a management plan, as well as the actions to be taken if a further vascular event occurs
e5s_19:
Advise on lifestyle, driving, work and family
e5s_20:
Identify local management and referral routes for TIA/stroke and mimics, and other conditions