Stroke pathway

A GP will perform the face arms and speech test on a patient. If the FAST test is positive, they'll immediateley call for an ambulance and the patient will be referred and admitted to a stroke unit at the nearest hospital.

On arrival, the diagnosis of a stroke should be checked using a test such as ROSiER (Recognition of Stroke in the Emergency Room). This will help differentiate the patients stroke and stroke mimics.

Dependent on age and severity, stroke referral will be made to:

• Stroke physician - The stroke physician contributes skilled acute care and advice on rehabilitation as part of a multidisciplinary team
• General physician - a person qualified to practise medicine, especially one who specializes in diagnosis and medical treatment as distinct from surgery.
• Geriatrician -  geriatrician, is a medical doctor who specializes in the diagnosis, treatment, and prevention of disease and disability in older adults. 
• Neurologist- the neurologist treats disorders that affect the brain, spinal cord, and nerves, 

Brain scan within an hour if it's severe. CT or MRI scan

Performed by a radiographer

CT -  This test can show areas of abnormalities in the brain, and can help to determine if these areas are caused by insufficient blood flow (ischemic stroke) or a ruptured blood vessel (hemorrhage)

MRI 

Helps determine if the brain scan is ischaemic or haemorrage 

A clot-bursting drug called alteplase may be given if the person's brain scan indicates they have an ischaemic. This treatment is known as thrombolysis. It improves blood flow and prevents clots. Treatment with alteplase must begin within 3 hours of stroke symptoms starting. Aspirin and anticoagulants may also be given depending on the results of CT or MRI scan. Some patients with an ischaemic may be given surgery to stop bleeding in the brain. 

Patients will be encouraged to be more mobile as soon as possible and blood sugar and blood pressure will be carefully monitored

Taken place in a stroke unit. Patients should be assessed and treated by a multidisciplinary team including:

• Speech therapist - Supports patient in communication and learning to speak more fluently
• Physiotherapist - Physiotherapy helps to restore movement and function when someone is affected by injury, illness or disability.
• Social worker - Your social worker should work with you to arrange any practical help that you need at home. This could include carers coming in to help you get washed and dressed, or adaptations for your home. 

Patients and their families should be given information on strokes and support available before discharge. Counselling can continue. Support groups recommended.