Amelia is a 68-year-old woman who was

Amelia is a 68-year-old woman who was brought into ED by her neighbour. She woke this morning at 0600 hours with a 5/10 headache. At 0700 she called her neighbour and asked her to bring her to hospital when she began to feel weak, and her headache increased to 7/10. At this time, one side of her face began to “feel strange”. She has past medical history of Atrial fibrillation (AF), hypertension (HT) and dyslipidaemia which she manages with Apixaban 2.5mg BD, Sotolol 80mg daily, Amlodipine 5mg daily, Irbesartan/hydrochlorothiazide 300/25mg daily, Rosuvastatin 10mg daily. Amelia used to smoke 20 cigarettes/day but states she quit 5 years ago. When she was brought into ED, she told staff that she did not take her medications this morning as she was too distracted by her increasing headache. You are assigned to care for Amelia. As you are about to enter her room, you overhear Amelia crying to her neighbour, explaining that she is worried as her mother had died of a stroke. ROSIER score Mild facial weakness Limb strength: Left side: normal; Right side: right arm no response, right leg weak A slight speech disturbance No visual issues CT scan of the Brain (CTB) Amelia has had a left middle cerebral artery occlusion. This artery irrigates the primary motor and somato-sensory corticol areas of the brain. Vital sign BP 180/94 HR 80 RR 19 SpO2 97% Temp 37 -BGL = 8.1mmol/L -GCS Eyes – Eyes remain open at all times Verbal – You ask Amelia what the year is, she responds by saying “It’s 2023”. You ask Amelia where she is and she responds by saying “in a hospital”. You ask Amelia what her name is and she responds “Amelia Hayes”. Motor – Amelia can obey all of your commands when asked. -Pupillary response assessment Both pupils are equal and reactive to light: 4+ -Limb strength assessment Right upper limb = none Right lower limb = mild weakness Left arm and leg = normal -ECG Amelia’s ECG shows she is experiencing Atrial Fibrillation (AF). – PQRST ASSESSMENT P: The pain is worse when Amelia moves her head suddenly – nothing seems to relieve the pain Q: The pain feels like extreme pressure on the left side of her head R: The pain is confined to her head S: 9/10 T: The first pain onset was about 4 hours ago Amelia’s pathology results pH 7.37 ( 7.3-7.4) PCO2 44 (40-50mmHg) PO2 95 (80-100mmHg) HCO3 28 (22-32meq/L) SaO2 97 (95-100%) Na+ 138 (134-145mmol/L) K+ 3.8 (3.5-5.0mmol/L) Cl- 100 (95-105mmol/L) Urea 6 (2.5-6.7mmol/L) Creatinine 130 (70-150μmol/L) RBC 6.0 (4.5-6.5 1012/L) WBC 8.0 (3.5-11.0 109/L) Platelets 360 (150-450 109/L) Hb 140 (115-165g/L) Hematocrit 0.44 (0.37-0.47 LL) Anti-Xa 8 Why Amelia’s case required prioritisation of care? Explain the underlying pathophysiology of the condition in relation to the abnormal clinical cues.

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