Emergency Medicine Journal ❲LATEST – ANTHOLOGY❳

Author: Dr. A. Rivers, Emergency Department, City General Hospital

Emergency Medicine Journal – Narrative Case Series Presentation It was a Tuesday afternoon in a busy UK district general hospital. The department was in its usual post-lunch chaos when triage flagged a 58-year-old man, Mr. Patel, as “priority 2 – possible stroke.” The paramedic handover was clipped: “Found by his wife at home, last known well 45 minutes ago. Sudden right-sided weakness, slurred speech, and facial droop. GCS 14. BP 185/100, HR 88, SpO₂ 97% on air. Blood glucose 6.2 mmol/L.” emergency medicine journal

“Status epilepticus? Or stroke progression?” James murmured. He gave 2 mg IV lorazepam. The jerking stopped, but the aphasia and hemiparesis remained unchanged. Author: Dr

James calculated: Door-to-needle time would be 82 minutes if they gave alteplase now. But giving thrombolysis before transfer to thrombectomy carries bleeding risk if the clot doesn’t move. The department was in its usual post-lunch chaos

Just then, the trauma patient was moved. The CT slot opened. CT head was performed at 67 minutes from onset: No haemorrhage. No early ischaemic changes on ASPECTS. CT angiography showed a proximal left middle cerebral artery (M1) occlusion with good collaterals.

The decision was shared with Mr. Patel’s wife, who tearfully agreed to both – “Do everything.”

The clock started. Dr. James Cooper, the emergency medicine registrar, met the patient in Resus 4. Mr. Patel was awake but unable to raise his right arm or leg. His speech was dense, global aphasia – not just slurred, but absent. He followed left-sided commands with his eyes. The face showed a pronounced right lower facial droop.