Stroke scenario (Acute Stroke)
Recognition of s/s (FAST)
Management in ER
Neurological Assessment (ICU)
Debriefing
Reference:
4. Emergency Department Evaluation and Management of Patients with Transient Ischemic Attack and
Acute Stroke | Canadian Stroke Best Practices
CHARACTERS
Patient
Kin
Staff
Doctor
Nurse
Neurologist
Scene 1: Recognition of Signs and Symptoms Using FAST
Setting: A living room where a family is gathered. One family member suddenly shows signs of distress.
Narrator: "When someone shows signs of a stroke, it's crucial to act quickly. Remember the
acronym FAST." Camera focuses on the affected individual.
Narrator:

Face: "Ask the person to smile. Is one side of their face drooping?"

Arms: "Have them raise both arms. Does one arm drift downward?"

Speech: "Ask them to repeat a simple phrase. Is their speech slurred or strange?"

Time: "If you notice any of these signs, call 911 immediately. Every minute counts."
The family member calls for emergency help.
Scene 2: Management of the Patient in the Emergency Room
Setting: Emergency room with medical staff preparing for the incoming patient.
Doctor: "We have a suspected stroke case coming in. Prepare for immediate assessment."
Nurse responds while checking equipment.
Nurse: "We'll stabilize the patient's airway, breathing, and circulation first."
As the patient arrives, the doctor begins a rapid assessment.
Doctor: "Initiate IV access and order a non-contrasted head CT immediately. We need to determine if it's
ischemic or hemorrhagic."
Nurse prepares lab tests and telemetry.
Nurse: "Vital signs are stable. Let’s monitor closely while we get imaging results."
Scene 3: Neurological Assessment in the ICU
Setting: Intensive Care Unit (ICU) with the patient being monitored closely.
Neurologist: "We need to perform a thorough neurological assessment using the NIH Stroke Scale."
The neurologist examines the patient’s responsiveness and motor skills.
Neurologist:

"Check cranial nerve function."

"Assess muscle strength and sensory response."

"Evaluate language capabilities and level of consciousness."
Nurse records findings on a chart.
Nurse: "Baseline function established. We’ll continue monitoring for any changes."
Scene 4: Debriefing
Setting: A conference room where medical staff gathers after managing the acute stroke case.
Lead Doctor: "Let’s review our response to this stroke case."
Staff members discuss their actions.
Lead Doctor:

"We acted quickly using FAST for recognition."

"In the ER, we prioritized stabilization and imaging."

"The ICU assessment was thorough, ensuring we documented everything accurately."
Nurse adds additional insights.
Nurse: "Teamwork was key in managing this emergency effectively."
The team nods in agreement, emphasizing the importance of preparedness and communication in stroke
management.
Narrator: "Recognizing stroke symptoms quickly and managing them effectively can save lives. Always
remember: Time is brain. Act FAST."
Fade out with contact information for local stroke awareness resources.
Scene 1: Recognition of Stroke Symptoms
Setting: A home living room. A family member is talking to an ambulance dispatcher on the phone.
Dispatcher (on the phone):
"Is your loved one showing any signs of stroke? Let me guide you through the FAST test."
Family Member (nervously):
"Yes, she seems to be acting strange. What do I do?"
Dispatcher:
"Okay, first, let’s check her face. Can she smile? Or does one side of her face droop?"
Family Member (looking at the patient):
"Her smile is uneven... one side of her face is drooping."
Dispatcher:
"Alright. Now, ask her to raise both arms. Does one arm drift downward or is she unable to raise it at
all?"
Family Member (frantic):
"Yes, her left arm is limp. She can’t lift it!"
Dispatcher:
"That’s a sign. Now, ask her to repeat a simple sentence. Can she speak clearly? Or does she sound
confused?"
Family Member (looking concerned):
"She’s slurring her words. She can’t say the sentence properly."
Dispatcher:
"That’s important. You need to act fast. Call 911 immediately, and don’t wait to see if symptoms
improve. It’s a stroke. Time is critical."
End Scene.
Scene 2: Patient Management in the ER
Setting: Emergency Room. A doctor and nurse are quickly assessing the stroke patient.
Doctor (to Nurse):
"Let’s get this patient to CT immediately to rule out hemorrhagic stroke. We need to confirm it’s an
ischemic stroke so we can administer tPA if appropriate."
Nurse (prepping equipment):
"CT ordered. I'll start an IV and prepare for thrombolytics if cleared by the scan. Blood pressure is a little
elevated, should we treat it now?"
Doctor:
"Not yet. We’ll monitor and control it later. First, let’s get the imaging and check for contraindications."
Nurse (nodding):
"Vitals stable. I’m prepping the tPA just in case."
Doctor:
"Good. Once we have the confirmation, we’ll initiate treatment right away. Let’s also alert the stroke
team."
End Scene.
Scene 3: Neurological Assessment in the ICU
Setting: ICU. The patient is now stabilized and is being assessed by the ICU team.
Neurologist (to Nurse):
"How’s the patient’s Glasgow Coma Scale score?"
Nurse:
"She's at a GCS of 13. She’s responding to verbal stimuli, but still a little confused."
Neurologist (checking patient’s pupils):
"Good. Let’s monitor for any changes. I’ll do a full neurological assessment—checking for any signs of
deterioration. Ask the family to be on alert."
Nurse (taking notes):
"I’ll do that. And I’ll keep track of her NIH Stroke Scale as well. Any changes in motor function or
speech?"
Neurologist (checking motor function):
"Still some weakness on the left side. We need to keep her in close observation for the next 24 hours."
Neurologist (speaking to family at bedside):
"We’re keeping a close eye on her neurological function. Recovery can take time, but we’ll do everything
we can to help her."
End Scene.
Scene 4: Debriefing
Setting: A hospital conference room. The medical team is meeting to debrief after the stroke case.
Doctor 1:
"Overall, the patient responded well to the tPA treatment, but we need to keep assessing her motor
functions. It’s important to remember that time is everything with strokes—every minute counts when it
comes to brain tissue."
Doctor 2:
"We did well recognizing the symptoms early. The FAST test was key in getting her to us quickly. That’s
something we should reinforce with every case."
Nurse:
"Agreed. And I think we can improve our communication in the ER. We had a few moments where we
were waiting on scans to confirm next steps, but the patient’s vitals were stable, so that helped."
Neurologist:
"Yes, and we’ll continue monitoring her closely in the ICU. Neurological assessments need to be
frequent. The family was well informed, and that helped reduce stress on them."
Doctor 1 (nodding):
"Good points all around. Let’s keep reinforcing the importance of early recognition and swift action, both
in and out of the hospital. The earlier we act, the better the recovery."
End Scene.
Fade Out.