E8: Assessment (stroke)

People with suspected acute stroke receive an immediate structured clinical assessment from the right people. (Key: e = element | k = knowledge | s = skill)

Knowledge and understanding of…

e8k_1:
The signs and symptoms of stroke
e8k_2:
The neurological and physiological effects of stroke and the timeframe of changes during and after a stroke
e8k_3:
How to monitor, and act upon, neurological and physiological changes during and after a stroke
e8k_4:
Implications of the Mental Capacity Act and how it applies to stroke and TIA
e8k_5:
Advocates for stroke patients when there is a legal duty to instruct an IMCA, taking account of religious and cultural aspirations
e8k_6:
Features of atypical presentation of stroke and stroke mimics
e8k_7:
Stroke types and their aetiologies
e8k_8:
Different modalities to facilitate diagnosis and treatment of stroke (e.g. telemedicine)
e8k_9:
Emergency investigations (e.g. imaging of brain, heart and cerebral arteries, blood tests) and interventions for stroke (e.g. intravenous and intra-arterial thrombolysis, vascular surgery, stenting, hemicraniotomy, evacuation of haematoma) and the timeframe within which they should be given
e8k_10:
The indications and contraindications for investigations, interventions and treatments for stroke
e8k_11:
Any complications of investigations, interventions and treatments for stroke and how to prevent and manage them

Skills and ability to...

e8s_1:
Take and interpret thorough history, record third party information where possible, and assess mental capacity
e8s_2:
Determine, plan and initiate appropriate assessments/investigations and interventions/treatments; provide information, relevant to individual needs and aspirations (personalise information)
e8s_3:
Perform neurological and physiological assessment and assess vital signs
e8s_4:
Perform a standardised neurological assessment using a recognised stroke scale (e.g. NIHSS, SNSS)
e8s_5:
Interpret the results of investigations (e.g. imaging, vascular, blood tests) and the actions to be taken as a result
e8s_6:
Diagnose stroke using clinical information and investigations: distinguish between a stroke and a TIA; identify atypical strokes and stroke mimics; formulate and implement a management plan accordingly
e8s_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
e8s_8:
Identify the need for more specialist or differing treatments when necessary
e8s_9:
Monitor progress, identify complications or deteriorations and deliver treatments for complications or deteriorations
e8s_10:
Identify the level of urgency for any relevant medical, surgical and radiological investigations, interventions and treatments
e8s_11:
Obtain and interpret the results of investigations and formulate an immediate and ongoing management plan; initiate treatments within the relevant timescales