Scenario — Sudden onset neurological symptoms — suspected stroke

intermediate Neurological · Adult · 35yr · female

Patient Information

Dispatch	A 35YO female (Mia Carrington) has been brought to the FAP by a friend at the Perth Royal Show. The friend says she suddenly started talking strangely and her face looks 'droopy' on one side.
Patient	Mia Carrington — 35yr (65kg)
Incident History	Pt was watching a show display with her friend when she suddenly complained of a headache, then her speech became slurred and her friend noticed her left arm 'went weak'. Onset approximately 20 minutes ago.
Emergency Contact	Daniel Carrington (Husband) — 0412 883 047

Initial Rapid Assessment

Response	Alert
Airway	Patent. Nil airway obstruction. Nil stridor. Mild pooling of saliva at left corner of mouth due to facial droop.
Breathing	Self-ventilating. Respiratory effort adequate. No accessory muscle use. No abnormal sounds.
Circulation	Radial pulse present — regular, moderate strength. Skin warm and dry. Nil external bleeding.
Disability	GCS 13 (E4V3M6). Confused — oriented to person only. Left facial droop noted. Left arm weakness on assessment. Slurred speech.
Exposure	Nil rashes, nil injuries, nil incontinence. Wearing casual clothing. Nil medic alert visible.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Nil	16	88	158/94	<2s	13	4 4 ++	36.8	6.2 mmol/L	6
10 mins	96% (RA)	Nil	17	92	162/96	<2s	12	4 4 ++	36.8	6.2 mmol/L	6

History Taking

Scenario Progression and Treatment Objectives

Diagnosis

This patient is suffering from a suspected acute cerebrovascular accident (stroke) with left-sided facial droop, left arm weakness, and dysphasia — onset within the last 20–30 minutes, placing her well within the 9-hour FAST+ window.

Facilitator Triggers — if trainees miss a critical step

! (If BGL is not checked within the first 5 minutes, the patient becomes more confused — GCS drops to 11 — and the facilitator states: 'Your partner asks whether you have ruled out hypoglycaemia.')
! (If the trainee does not note the time of symptom onset and document it, the facilitator prompts: 'The receiving hospital calls back and asks you — what time did symptoms start? You are unsure.')
! (If oxygen is applied unnecessarily to a patient with SpO2 97% on room air without clinical indication, prompt the trainee: 'What is your SpO2 target for this patient and is supplemental oxygen indicated?')
! (If the trainee attempts to administer any medication other than oxygen if indicated, prompt: 'What medications are you authorised to administer for this presentation?')
! (If urgent ambulance is not requested within 5 minutes of assessment, GCS drops to 11 and left arm becomes flaccid — facilitator states: 'The patient's condition is deteriorating. What is your transport priority?')

Treatment Objectives

1. Ensure scene safety and don appropriate PPE.
2. Perform Primary Survey — open, clear and maintain airway; note pooling of saliva and position patient appropriately (lateral position if airway at risk); assess breathing and circulation.
3. Establish and document exact time of symptom onset — approximately 20 minutes ago (well within 9-hour window).
4. Perform Vital Sign Survey including GCS, BGL, SpO2, BP, RR, HR, temperature, and pupils.
5. Check BGL — result 6.2 mmol/L, ruling out hypoglycaemia as cause of altered conscious state.
6. Administer Oxygen only if clinically indicated — SpO2 97% on room air does not meet threshold; do NOT apply oxygen if SpO2 maintained ≥94%.
7. Recognise FAST+ criteria: Left facial droop (Face), Left arm weakness (Arms), Slurred speech (Speech), Onset <9 hours (Time) — patient is FAST+.
8. Recognise this is a time-critical presentation — minimise on-scene time.
9. Request Priority 1 ambulance immediately with pre-notification to receiving facility — communicate FAST+ findings, time of onset, and patient GCS.
10. Place patient in position of comfort — seated or semi-recumbent with head support; use lateral position if airway becomes compromised.
11. Provide continuous reassurance to patient and companion; keep patient calm and limit exertion.
12. Do NOT administer aspirin — haemorrhagic stroke cannot be excluded in the field.
13. Record full observations every 5 minutes given time-critical status and document all findings for IMISTAMBO handover.
14. Prepare IMISTAMBO handover: Identity — Mia Carrington, 35F; Mechanism — sudden onset neurological symptoms at public event; Injuries/Illness — suspected acute CVA with FAST+ findings, left facial droop, left arm weakness, dysphasia, GCS 13; Signs — BP 158/94, HR 88, SpO2 97% RA, BGL 6.2, GCS 13; Treatment — oxygen if indicated, monitoring; Allergies — Nil known; Medications — OCP; Background — Nil prior stroke/TIA, on OCP; Other — symptom onset approximately 20 minutes ago, within 9-hour window.
15. Scenario ends on arrival of ambulance and IMISTAMBO handover.
16. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Stroke (Cerebrovascular Accident) · Primary Survey · Oxygen · Blood Glucose Monitor · Glasgow Coma Scale (GCS)

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Signs/Symptoms	Sudden onset severe headache, slurred speech, left-sided facial droop, weakness of left arm. Mild confusion.
Allergies	Nil known allergies.
Medications	Oral contraceptive pill (combined). No other regular medications.
Pertinent History	Nil prior episodes. Nil known cardiac conditions. Nil prior stroke or TIA. Non-smoker. Social alcohol only. Nil illicit drug use.
Last Oral Intake	Ate a meat pie and soft drink approximately 1 hour ago.
Events Leading	Patient was standing watching a livestock display at the Perth Royal Show when she developed a sudden severe headache followed rapidly by left-sided weakness and speech difficulty.
Treatment Prior	Nil. Friend walked her directly to the FAP.

Onset	Sudden onset approximately 20 minutes ago while stationary at the showgrounds.
Pain	Severe headache — sudden onset, 'worst headache of my life', located across the entire head.
Quality	Headache described as 'like something hit me in the head'. Constant.
Radiates	Nil radiation from headache.
Severity	6/10 pain score for headache.