EM Cases · Acute ischaemic stroke
Acute ischaemic stroke with large-vessel occlusion — resus station
An ACEM Fellowship OSCE clinical-management (resus) station. Tests stroke recognition, glucose, BP thresholds, exact alteplase dosing, CTA-driven thrombectomy activation, and team leadership. ACEM-primary, globally tagged.
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Target exams
ACEMFRCEMABEMFRCPCCCFPEMEBEEM
Prompt
A 64-year-old man with sudden dense left hemiparesis and neglect 70 minutes after last known well; CT excludes haemorrhage; CTA shows right M1 occlusion.
Station brief
Format. Clinical-management (resus) station, 11 minutes total — 4 minutes reading, 7 minutes active assessment. You are the Emergency Medicine consultant leading the stroke code.
Candidate instruction. Manage the patient from ambulance arrival through reperfusion decisions. The examiner plays nursing and retrieval. State actions and reasoning aloud.
References4ShowHide
- [1]National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group Tissue plasminogen activator for acute ischemic stroke. New England Journal of Medicine, 1995.PMID 7477192
- [2]Berkhemer OA, Fransen PSS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke (MR CLEAN). New England Journal of Medicine, 2015.PMID 25517348
- [3]Prabhakaran S, Gonzalez NR, Zachrison KS, et al. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association. Stroke, 2026.PMID 41582814
- [4]Menon BK, et al. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT). Lancet, 2022.PMID 35779553