Stroke screen: face droop, arm drift, speech trouble — plus balance and eyes (BE-FAST).
Before you read
Test yourself first: 5 questions
Question 1 of 5
Which three findings make up the Cincinnati Prehospital Stroke Scale?
Answer: A. The Cincinnati scale checks for a facial droop when smiling, drift when both arms are held out, and slurred or wrong words. Any one abnormal finding is concerning for stroke. The other combinations describe different conditions or are not part of the scale.
Question 2 of 5
For a patient with signs of stroke, the single most important piece of history to obtain is:
Answer: A. Hospital stroke treatments depend on how long ago symptoms began, and the reliable anchor is the last time the patient was seen normal. A patient who woke with symptoms was last known well when they went to bed. The other details are useful but do not decide treatment.
Question 3 of 5
What most clearly separates heat stroke from heat exhaustion?
Answer: A. Heat stroke is defined by a high body temperature with altered mental status, and it is a life-threatening emergency. Sweating may or may not be present. Cramps, thirst, nausea and headache occur in the milder heat illnesses.
Question 4 of 5
An older patient with a severe stroke breathes in cycles: breaths grow steadily deeper, then shallower, then stop for several seconds before the cycle repeats. This pattern:
Answer: A. A crescendo-decrescendo cycle of breathing with periods of apnea between cycles is Cheyne-Stokes respiration, seen with serious brain injury, stroke and severe heart failure, and it is a sign to watch ventilation closely and be ready to assist. Kussmaul breathing is deep and rapid without pauses, typical of metabolic acidosis, and anxiety hyperventilation does not include repeated periods of apnea.
Question 5 of 5
A prehospital stroke screen asks the patient to smile, hold both arms out and repeat a sentence. An abnormality in any one of the three:
Answer: A. The screen is a probability tool: one abnormal element substantially raises the likelihood of a stroke and is enough to act on. Requiring all three before you take it seriously would delay the patients who present with a single deficit, which is a very common way a stroke first shows itself.
Keep the streak going with more questions like these, each with a full rationale.
What is stroke & seizures?
Seizure care is mostly protection: keep the patient from harm, support the airway afterward and recognize when a seizure will not stop.
Key points to remember
- Stroke screen: face droop, arm drift, speech trouble — plus balance and eyes (BE-FAST).
- Time last known well is the clock, not the time the symptoms were found.
- Check blood glucose — low sugar can mimic a stroke exactly.
- During a seizure: protect the head, move hazards away, nothing in the mouth, never restrain.
- After a seizure: recovery position, suction as needed, expect confusion that slowly clears.
Field priorities
- Positive stroke screen: short scene time and early notification of the receiving facility.
- Status epilepticus: seizure lasting 5 minutes or repeated without waking — treat as critical.
- Give oxygen only for low saturation or distress; support ventilation if breathing is inadequate.
Coaching the patient
- A postictal patient improves over minutes; a patient who does not improve needs a new cause.
- Weakness on one side after a seizure can occur, but assume stroke until proven otherwise.
Red flags: act now
- Symptoms that fully resolved (TIA) — still a stroke warning
- Sudden worst headache of life
- A seizure in pregnancy (eclampsia)
Stroke & Seizures: FAQs
What are the priority actions for Stroke & Seizures in the field?
Positive stroke screen: short scene time and early notification of the receiving facility. Status epilepticus: seizure lasting 5 minutes or repeated without waking — treat as critical. Give oxygen only for low saturation or distress; support ventilation if breathing is inadequate.
What findings in Stroke & Seizures change your plan or your transport decision?
Symptoms that fully resolved (TIA) — still a stroke warning. Sudden worst headache of life. A seizure in pregnancy (eclampsia).
What do I need to know about Stroke & Seizures for the NREMT?
Stroke screen: face droop, arm drift, speech trouble — plus balance and eyes (BE-FAST). Time last known well is the clock, not the time the symptoms were found. Check blood glucose — low sugar can mimic a stroke exactly. During a seizure: protect the head, move hazards away, nothing in the mouth, never restrain.
What should the crew communicate or document for Stroke & Seizures?
A postictal patient improves over minutes; a patient who does not improve needs a new cause. Weakness on one side after a seizure can occur, but assume stroke until proven otherwise.
