CVA

Mid complexity — Central Nervous System

Goals

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

Anamnese

  • Name: Mr Diamant
  • Age: 64 years
  • Family: Married
  • Occupation: Notary
  • Cultural: Not known

AMPLE

A: Unclear

M: Aspirin, sotalol PRN

P: Hypertension, atrial fibrillation

L: Unclear

E: Cardiac arrhythmias, confusion

SBAR

S: Mr Diamant is admitted to your ward for observation due to cardiac arrhythmias. A colleague is now asking you to check on him because he appears confused.

B: Mr Diamant is 64 years old and has a history of hypertension and 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, slight left-sided facial droop.

B: RR 16 breaths/min, normal depth, symmetrical thoracic excursions, normal jugular veins, normal breath sounds, saturation 88%.

C: Ashen colour, CRT 1 sec, HR 65 bpm, strong regular pulse, warm dry skin, BP 162/88.

D: Voice on AVPU, dysarthria, glucose 4.3, pupils PEARL. Left facial droop.

E: Temp 37.1°C, no oedema. Urine output: spontaneous 450 ml 1 hour ago.

Situation at the end of scenario

A: Potentially compromised airway, unconscious.

B: RR 14 breaths/min, symmetrical thoracic excursions, normal jugular veins, normal breath sounds, saturation 85%.

C: Ashen colour, CRT 1 sec, HR 55 bpm, strong regular pulse, warm dry skin, BP 193/95.

D: Pain on AVPU, glucose 5.3, pupils PEARL. Increasing left facial droop.

E: Temp 37.1°C, no oedema.

Recommendations

  • Brain CT scan as soon as possible