Neurological Examination
Altered consciousness — suspected stroke / neurological emergency
This station is for CPD and OSCE practice only. Not a regulated qualification or formal competency sign-off. Always work within your scope of practice, local policy, employer guidance and current UK clinical guidelines.
“Category 2 — 67-year-old female, sudden onset facial droop and left arm weakness reported by husband. Onset approximately 35 minutes ago. Patient is conscious but confused. No history of trauma.”
You are a Paramedic responding solo with a double-crewed unit en route as backup. On arrival, Patricia, 67, is seated in her armchair. Her husband David reports a sudden onset of facial droop and left-sided weakness starting approximately 35 minutes ago. She is conscious but confused and not answering questions coherently. You have full paramedic equipment including glucometer, ECG, and 12-lead capabilities. This station assesses your neurological examination and emergency stroke management per NICE NG128, JRCALC 2024, and Resus UK ABCDE guidelines.
- NICE NG128: All FAST+ patients must be transferred directly to a HASU — not the nearest ED.
- JRCALC 2024: Blood glucose is mandatory in ALL neurological presentations — hypoglycaemia is a fully reversible stroke mimic.
- NICE NG128: Do NOT lay acute stroke patients flat — 15° head elevation reduces aspiration risk and ICP.
- NICE NG128: Do NOT routinely treat hypertension in acute stroke pre-hospital — cerebral autoregulation is impaired.
- JRCALC 2024 / NICE NG128: Avoid routine high-flow oxygen in stroke — hyperoxia is associated with worse neurological outcomes. Only supplement if SpO2 <94%.
- Anisocoria in altered consciousness may indicate raised ICP or uncal herniation — urgent CT required.
- Warfarin anticoagulation is critical information for thrombolysis team — INR >1.7 is a contraindication to thrombolysis.
- Atrial fibrillation is the commonest cause of cardioembolic stroke — 12-lead ECG is essential.
- GCS ≤14 in suspected stroke mandates HASU pre-alert regardless of whether symptoms appear to be resolving.
- Time is brain — approximately 1.9 million neurones die per minute in ischaemic stroke. Minimise on-scene time.