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STROKE: ROUTINE CAREDrSudden onset of any of the following suggests a stroke (or a transient ischaemic attack (TIA) if symptoms lasted < 24 hours and resolved completely):• Weakness, numbness or paralysis of the face, arm or leg on one or both sides of the body• Blurred or decreased vision in one or both eyes or double vision• Difficulty speaking or understanding• Dizziness, loss of balance, any unexplained fall or unsteady gait• Severe new headacheA doctor must confirm the diagnosis of stroke.Recognise the patient with stroke needing urgent attention:Stroke/TIA is a brain attack. Quick treatment within 48 hours of onset of symptoms of a minor stroke or TIA reduces the risk of a major stroke.• Give face mask oxygen.• Nil by mouth until swallowing is formally assessed.• Check blood glucose: if ≤ 3.5 give up to 50ml dextrose 50% IV.• Do not treat raised BP as this may worsen stroke and can be managed at referral hospital.• Give aspirin 150mg stat if patient unable to reach hospital within 24 hours of onset of symptoms.• Refer urgently for thrombolysis (to a specialist stroke unit if available) if the patient can reach the unit/hospital within 4 hours of onset of symptoms.• Otherwise refer same day to nearest hospital if symptoms of stroke/TIA > 4 hours but < 48 hours.Assess the patient with stroke/TIAAssess When to assess NoteSymptoms Every visit Ask about symptoms of another stroke/TIA. Also ask about chest pain 77 or leg pain 79.Depression Every visit Screen for depression if patient has low mood or not coping as well as in the past 81.Rehabilitation needs Every visit Refer to appropriate therapist: physiotherapy for mobility, physiotherapy/occupational therapy forself care, speech therapist for swallowing, coughing after eating, speaking and drooling.BP Every visit Aim for BP < 130/80. Start treatment only 48 hours after a stroke 73.Glucose At diagnosis and yearly Check random finger-prick glucose 70 to interpret result.Fasting cholesterol and triglycerides At diagnosis if not already done Refer to specialist if total cholesterol ≥ 7.5 or triglycerides ≥ 5.HIV At diagnosis if status unknown especially if patient < 50 years Test for HIV 60. The HIV patient needs routine HIV care 61.Advise the patient with stroke/TIA• Help patient to manage cardiovascular disease risk 69. Refer patient to available helpline/s backpage.• If patient is < 55 years (man) or < 65 years (woman), advise the first degree relatives to have CVD risk assessment 68.• Avoid oral contraceptives containing oestrogen. Advise other method such as IUCD, injectable, progesterone-only pill 91.Treat the patient with stroke/TIA• Give aspirin 150mg daily for life. Avoid if < 30 years, haemorrhagic stroke, previous peptic ulcers or dyspepsia.• Refer for warfarin instead of aspirin if patient has prosthetic heart valve, valvular heart disease or atrial fibrillation.• Give simvastatin 10mg daily for life if patient had an ischaemic stroke.CHRONIC DISEASESOF LIFESTYLE76