At 0800, a 72-year-old client is brought to the emergency department by the spouse, who reports the client was speaking normally at 0715 during breakfast and then suddenly could not get words out. The client understands simple requests but answers in short, effortful phrases. History includes hypertension, hyperlipidemia, migraine with aura since age 30, and a single seizure after a fall in 2014; the client takes no anticonvulsant or anticoagulant. The spouse saw no shaking, and the client reports no headache or visual change today. The eyes deviate toward the left, there is a right lower facial droop, and the right arm drifts to the bed when held up. The client wears a hearing aid in the right ear and has months of nighttime right-hand tingling, diagnosed last year as carpal tunnel syndrome. Vital signs: BP 178/96 mm Hg (unchanged on repeat at 0805 and similar to home readings), HR 88/min, RR 18/min, temperature 36.8 C, SpO2 96% on room air. Point-of-care glucose 118 mg/dL.
At 0800, a 72-year-old client is brought to the emergency department by the spouse, who reports the client was speaking normally at 0715 during breakfast and then suddenly could not get words out. The client understands simple requests but answers in short, effortful phrases. History includes hypertension, hyperlipidemia, migraine with aura since age 30, and a single seizure after a fall in 2014; the client takes no anticonvulsant or anticoagulant. The spouse saw no shaking, and the client reports no headache or visual change today. The eyes deviate toward the left, there is a right lower facial droop, and the right arm drifts to the bed when held up. The client wears a hearing aid in the right ear and has months of nighttime right-hand tingling, diagnosed last year as carpal tunnel syndrome. Vital signs: BP 178/96 mm Hg (unchanged on repeat at 0805 and similar to home readings), HR 88/min, RR 18/min, temperature 36.8 C, SpO2 96% on room air. Point-of-care glucose 118 mg/dL.