My patient has slurred speech but…. WWYD?

zebrahtI sent this email to my members the other day about a possible stroke call I had.

Most of us expect that one sided droop, weakness, slurred speech or no speech deal.

What I get is a 78 y/o female completely alert who says she feels like her speech is slurred.

I do note some slurring. But no facial droop, negative Cinninatti Scores etc.

She also complains of headache that has been worsening over past 3 hours and numbness to her right hand for the past 20 mins, which is about the time she noticed her sleech issues.

When doing my history taking she can’t seem to recall details like why she takes a medication.

She says she feels “dopey” like she can’t formulate her thoughts as she usually can.

Her BP was 176/100, HR 88, RR 18, Sp02 98% on room air.

Here is what I did.

I called this in as a Code Stroke. Started an IV, gave 02 via NC and perfromed a 12 lead.

To me although she wasn’t presenting like a classic stroke patient, there where enough signs and symptoms to suspect that one may be occuring.

It may even have been a TIA.

But I felt better to up triage and treat as a CVA than blow it off and have her suddenly get worse enroute to the ED.

Plus I always worry that if I don’t point out my suspicsions she would end up in a ED room or hallway and not be seen for 10-15 mins or longer and suddenly a nurse will think “hey this may be a stroke” and now precious time has past where the alert talking patient is now unable to communicate or move her entire right side.

So, what would  you do in this case? The same? Totally opposite?

I’d be interested to know if you think her complaints warranted a priority transport or not.

Leave your comments below with your thoughts and keep an eye out for a follow up on this in a few days.

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