FAST (stroke)

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FDA infographic teaching the FAST mnemonic

FAST is an acronym used as a mnemonic to help early recognition and detection of the signs and symptoms of a stroke. The acronym stands for Facial drooping, Arm (or leg) weakness, Speech difficulties and Time to call emergency services.[1]

  • F - Facial drooping - A section of the face, usually only on one side, that is drooping and hard to move. This can be recognized by a crooked smile, or difficulty preventing saliva from leaking at a corner of the mouth.
  • A - Arm (or leg) weakness - Inability to raise one's arm fully, or the inability to hold or squeeze something (such as someone's hand), or a new reduction in strength of an arm or leg when raising/supporting an extra weight (such as new difficulty of carrying/lifting a typical object, or raising one's body from squatting/sitting position).
  • S - Speech difficulties - An inability or difficulty to understand or produce speech, slurred speech, or having difficulty repeating even a basic sentence such as "The sky is blue".
  • T - Time - If any of the symptoms above are showing, time is of the essence; emergency medical services should be called and/or the person taken to a hospital immediately if possible.[1] It is also important to note the time the symptoms first started appearing and pass on this information ("Time is brain"[2]).

History

The FAST acronym was developed in the UK in 1998 by a group of stroke physicians, ambulance personnel, and an

Los Angeles Prehospital Stroke Screen (LAPSS).[3]

Studies using FAST have demonstrated variable diagnostic accuracy of strokes by paramedics and emergency medical technicians with positive predictive values between 64% and 77%.[4]

Other acronyms such as BE-FAST has shown promise by capturing >95% of ischemic strokes,[5] however adding coordination and diplopia assessment did not improve stroke detection in the prehospital setting.[6]

Alternative versions

BE-FAST has shown promise and is currently being studied as an alternative method to the FAST acronym.[5]

  • B - balance degradation - increase in difficulty of maintaining balance while walking (especially when using stairs or changing direction), or standing (especially when standing on one foot); now needing assistance using a hand on something such as a hand-rail or cane.
  • E - eyesight degradation within a continuous period of consciousness (less than 12 hours), such as greater difficulty focusing on detail of an object or discerning low-contrast detail.

The other components are as for the classic FAST mnemonic.

  • F - Face
  • A - Arm
  • S - Speech
  • T - Time

NEWFAST (c) is an additional stroke identification tool available for use. Copyrighted by Deborah Stabell Tran in 2017, (and created in 2016) as part of a DNP project, it was created to identify all types of strokes - anterior or posterior ischemic, and hemorrhagic strokes. It gives more definition to testing dizziness and balance, hallmark signs of posterior strokes. NEWFAST also addresses the sudden onset of a severe headache and vomiting that often accompany bleeds in the head.[7]

  • NEW - means a NEW onset of symptoms (generally within the past 24 hours, but a sudden onset in general).
  • N - Nausea/Vomiting - sudden onset
  • E - Eyes - Double vision, field cut, neglect (can't see or notice what is going on, on one side of the body), and/or nystagmus(eyes involuntarily shifting back and forth)
  • W - Walking - If you suddenly can not walk due to dizziness, or your try to walk and you shift to one side.
  • F - Facial droop - one side of the face is droopy
  • A - Arm Weakness - especially one side being weak
  • S - Speech - slurred, confused, and/or absent speech
  • T - Terrible Headache/Dizziness (often described as thunderclap headache or dizziness regardless of position of body - sitting, standing, or laying down)

FASTER is used by Beaumont Health.[8]

  • F - Face - Facial drooping or numbness on one side of the face
  • A - Arms - Arm weakness on one side of the body
  • S - Stability - Inability to maintain balance and stay steady on one's feet; dizziness
  • T - Talking - Slurred speech, inability to respond coherently, or other speech difficulty
  • E - Eyes - Changes in vision, including seeing double, or partial or complete blindness in one or both eyes
  • R - React - Call emergency services immediately if you see any of these symptoms, even if symptoms go away

References

  1. ^ a b "Stroke Warning Signs and Symptoms". www.strokeassociation.org. Retrieved 2017-01-03.
  2. PMID 16339467
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  3. PMID 12511753
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  4. PMID 12511753
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  5. ^
    PMID 28082668
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  6. PMID 30118372
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  7. ^ Tran, D.S. (2017). NEWFAST: A New Stroke Identification Tool. [Poster]. AANN Stroke conference. Chicago, IL
  8. ^ "Stroke Symptoms: From FAST to FASTER". www.beaumont.org. Retrieved 2021-03-11.


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