The 5 fingers of stroke

Did you get the stroke etiology right?

I love checklists with 5 items – 5 things to ask for in CHF, 2 x 5 things to remember in delirium. By looking at any of your hands, you can understand and work down the checklist. So here is my 5 item checklist for acute stroke care – designed for handovers.

  1. Stroke characteristics:
    1. syndrome
    2. localization
    3. imaging results
    4. pattern
    5. confidence (couldn’t it be a mimic?)
  2. Acute stroke treatment: tPA? endovascular therapy? Any early neurological deterioration?
  3. Etiology: determines secondary prevention measures. I use ASCO
    1. risk factors
    2. atherosclerosis (big vessels – ultrasound results? CTA/MRA?),
    3. small vessels aka microangiopathy (CT/MRI)
    4. cardiac (ECG, monitor, further results)
    5. other etiologies
  4. Complications: the big 5 are
    1. infection
    2. cardiac (rhythm, troponin)
    3. pressure
    4. gut problems
    5. thrombosis
  5. Rehabilitation
    1. physiotherapy
    2. ergotherapy
    3. logopedic (aka SLT) therapy
    4. social services?
    5. rehabilitation planned?
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