Stage

Title

Content

Associated National Stroke Strategy Quality Marker Number

1

07:00

Symptom onset

Describes the circumstances surrounding the stroke (usually in the home or community) and lists the symptoms and signs. Information is extracted from the video of the clinical assessment and from the patient record created by the treating physician and nurse. A computer generated simulation of the patient was used to simulate where possible the presenting visual appearance of facial symptoms and/or signs.

1: Awareness raising

2

10:03

Recognition

Describes the moment when the stroke is identified by the family member or carer who calls the emergency services. The media in this slide utilises the public NHS FAST campaign information.

1: Awareness raising

3

10:15

Initial assessment

Describes the first contact with health-care professionals as the paramedics arrive and allows the learner to calculate the 12 minute time delay between recognition at 10:03 and initial assessment at 10:15.

5: Assessment

4

10:37

Priority ambulance call

Summarises the vital signs reported by the paramedics including temperature, pulse rate, blood pressure, GCS (Glasgow Coma Scale) score and blood glucose level.

7: Urgent Response

5

10:58

Delivery and admission

Encapsulates the handover from the paramedic to the HASU team in the emergency department. This slide includes an audio recording of the handover in the emergency department, supported by a short summary of the key facts of the case from the paramedics” viewpoint.

7: Urgent Response

6

11:00

Neurological examination

Contains real video footage of the stroke patient being examined neurologically using the NIHSS (National Institute of Health Stroke Scale) assessment.

8: Assessment

9: Treatment

7

11:08

Systems enquiry

Utilitises the emergency assessment video taken in the emergency department providing a smooth transition from the purely neurological assessment to a more general clinical examination.

8: Assessment

9: Treatment

8

11:23

Investigations

Blood tests collected during admission are sent off to the laboratory for investigation. Additionally, depending on the presentation, other emergency tests, including an electrocardiogram (ECG) and/or chest X-ray may be scheduled and performed. The results of these tests are encompassed within this slide with annotation of media to outline salient features.

8: Assessment

9: Treatment

9

11:40

Brain imaging

Brain imaging employed in stroke patients includes CT (computed tomography), CT-angiography, MR (magnectic resonance) and MR-angiography that identify the location and nature of cerebral pathologies. The results of brain imaging are included on this slide with annotated images from the scans being supported by audio commentary from expert neuroradiological analysis.

8: Assessment

9: Treatment

10

Pathophysiology

Once the results of all clinical and investigative assessments are available, the stroke diagnosis, location and cause (aetiology) may be determined. These elements can be grouped together under the heading of “Pathophysiology”. The visualization of the location of the haemorrhagic or ischaemic stroke is presented as a 3D graphic identifying the causative blood vessel(s) involved. The pathophysiology indicates what form of immediate treatment, subsequent investigations and secondary prevention is needed for the patient, providing a link to the next slide.

9: Treatment