Endocrine Case Report: Stroke Code?


Check out our latest emergency department case report from Dr. Brady Pregerson. Can you determine the correct diagnosis?

History of Present Illness:

A woman in her late 70’s is brought to the ER by medics for facial droop, slurred speech, and left-sided weakness. She lives at a nursing home and at baseline is bedridden but A+Ox4 and able to feed herself. She was last seen normal about 1.5 hours prior to ER arrival. Her PMH includes stroke, HTN, DM, CAD, CHF, AFib, and GERD. She is hard to understand due to her slurring but does complain of headache without vomiting. No other complaints.

Vital Signs & Physical Exam:

Vital signs are normal except for BP 171/89. Physical exam is notable for weakness in all extremities but she is able to lift her right arm and leg off the bed but not the left side, though she can move it a little. Speech is slurred to the point of being difficult to understand with left facial droop. Heart is regular and lungs are clear. Her skin is dry. A stroke code order set is entered.

What is the most important question to ask the medics before they leave?

A) Is she on blood thinners?

B) What is the last known well time?

C) What is the finger-stick?

D) What is the code status?

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