CVA

Low complexity — Central Nervous System

Goals

  1. Recognise neurological abnormalities using the ABCDE method.
  2. Name the treatment for a CVA and the importance of the short time window.
  3. Recognise and describe the risk factors for a CVA.

Anamnese

  • Name: Mr Boonen
  • Age: 69 years
  • Family: Married
  • Occupation: Retired
  • Cultural: Not known

AMPLE

A: Unknown

M: Acetylsalicylic acid, flecainide as needed

P: Peripheral vascular disease and paroxysmal atrial fibrillation

L: Unclear

E: Cardiac arrhythmias, confusion

SBAR

S: Mr Boonen is admitted to your ward for medication adjustment for atrial fibrillation. A colleague is now asking you to go and check on him because he appears confused.

B: Mr Boonen is 69 years old and has a history of peripheral vascular disease and paroxysmal atrial fibrillation.

A: See ABCDE

R: Please assess the patient using ABCDE and apply interventions where necessary.

Situation at the start of scenario

A: Clear airway, slurred speech, slightly drooping left corner of the mouth.

B: RR 17 breaths/min, normal depth, symmetrical thoracic excursions, normal jugular veins, normal breath sounds, saturation 91%.

C: Greyish colour, CRT 1 sec, HR 71 bpm, strong regular pulse, warm dry skin, BP 157/82.

D: Voice on AVPU, dysarthria, glucose 4.9, pupils PEARL. Slightly drooping left corner of mouth.

E: Temp 37.0°C, no oedema. Urine output: spontaneous 350 ml 2 hours ago.

Situation at the end of scenario

A: Potentially compromised airway, unconscious. Increasing droop of the left corner of the mouth.

B: RR 12 breaths/min, symmetrical thoracic excursions, normal jugular veins, normal breath sounds, saturation 87%.

C: Greyish colour, CRT 1 sec, HR 66 bpm, strong regular pulse, warm dry skin, BP 175/92.

D: Pain on AVPU, glucose 4.9, pupils PEARL. Increasing droop of left corner of mouth.

E: Temp 37.1°C, no oedema.

Recommendations

  • Brain CT scan as soon as possible