A 72-year-old man presents with sudden facial droop and dysarthria. While awaiting transfer by ambulance, what is the most appropriate immediate step in urgent care?

A 72-year-old man presents with sudden facial droop and dysarthria. While awaiting transfer by ambulance, what is the most appropriate immediate step in urgent care?

• A. Perform non-contrast CT head
• B. Administer aspirin 325 mg
• C. Obtain blood glucose level
• D. Start intravenous tPA

Answer: (C)

The key idea here is to quickly rule out a reversible cause of neurologic symptoms, especially hypoglycemia, which can mimic a stroke. Measuring a capillary blood glucose is the fastest, simplest step you can take in the urgent setting. If the glucose is low, you can treat it right away and see if the neurologic deficits improve, avoiding unnecessary imaging or thrombolysis. If glucose is normal, you then proceed with stroke evaluation (imaging to distinguish hemorrhage from ischemia and determine eligibility for reperfusion therapy). Why not other steps right away? Non-contrast CT head is crucial before giving reperfusion therapy, but it isn’t the immediate action you take before ruling out hypoglycemia, since a quick glucose check can prevent misdiagnosis and delays. Administering aspirin or starting tPA requires imaging results and time-window considerations, which you don’t have yet in this moment, whereas a glucose check is immediately available and safety-critical.

The key idea here is to quickly rule out a reversible cause of neurologic symptoms, especially hypoglycemia, which can mimic a stroke. Measuring a capillary blood glucose is the fastest, simplest step you can take in the urgent setting. If the glucose is low, you can treat it right away and see if the neurologic deficits improve, avoiding unnecessary imaging or thrombolysis. If glucose is normal, you then proceed with stroke evaluation (imaging to distinguish hemorrhage from ischemia and determine eligibility for reperfusion therapy).

Why not other steps right away? Non-contrast CT head is crucial before giving reperfusion therapy, but it isn’t the immediate action you take before ruling out hypoglycemia, since a quick glucose check can prevent misdiagnosis and delays. Administering aspirin or starting tPA requires imaging results and time-window considerations, which you don’t have yet in this moment, whereas a glucose check is immediately available and safety-critical.