Neurology
ALS Stroke & Neurologic Emergencies
FAST-positive screening, glucose checks, blood pressure nuance, and stroke-center transport for time-sensitive neuro care.
Prehospital stroke bundle
The CDC urges calling EMS immediately when stroke symptoms appear—ambulance arrival triggers hospital stroke team activation and shortens treatment delays.1 Document last known well time, perform FAST or BE-FAST exam, check blood glucose, and establish IV access per protocol. Seizure at onset does not exclude stroke but requires glucose and airway assessment first.
Large vessel occlusion may present with minimal cortical signs—gaze preference, neglect, or isolated aphasia. Prehospital stroke scales (CPSS, RACE, LAMS) supplement FAST for severity estimation and bypass decisions to thrombectomy-capable centers when protocol allows.
Blood pressure and transport nuance
MedlinePlus lists sudden weakness, confusion, and severe headache as stroke warnings requiring emergency evaluation.2 Permissive hypertension is often maintained prehospital for acute stroke—aggressive lowering may reduce perfusion to ischemic penumbra unless protocol specifies exceptions for extreme pressures with concurrent MI or heart failure.
Avoid oral intake; position for airway protection if decreased consciousness. Notify receiving facility with ETA, glucose, vitals, and exam findings. Post-stroke seizure management follows benzodiazepine protocol without delaying transport—time loss directly reduces intervention eligibility.
Practice this skill
Apply what you read with a hands-on Stroke & Neurology drill — instant feedback on every scenario.
