Hi doctor kaitlyn hi there hi have you got the case yeah she got the specialist call yeah she got dropped her what's the first name she gets out of the of the bus at 11:30 by coming to work and then she just went 3 steps and collapsed she don't know what happened she found herself on the floor didn't hit her head she I don't think I have yeah but I don't actually remember she came in great great member but I came in because I've got a lot of pins and needles and stiffness in my arm again okay and before bear bear bear with me 2 years ago I collapsed I work in radiology I I collapsed in ct mhmm same same situation I was fine 1 minute and then suddenly I couldn't speak couldn't walk couldn't move my left my left side just seemed to keep just gone that's strange can tell me why they but put it down to a paralytic headache yeah a migraine yeah you got a headache now I've I've always got a migraine have you always always 247 247 I I take a load of medication medication to to keep the pain at bay mhmm and that but why I keep falling I don't know obviously if you're feeling weak on this side then you could fall couldn't you but you you might have lost consciousness is that right I don't I don't know nobody came to help I I I kinda was laying on the pavement I guess I think it was it did to to me it didn't seem long mhmm but time I literally worked out where I was I tried I tried I got my sorry about this don't worry it's hard when you go to our website to talk about this stuff I I got myself up and then I literally felt dizzy all the way walking up into work mhmm and 1 of my colleagues has like cleaned me up a bit and did you hurt your arm when you cut yeah it scraped it and this this these 2 things it it's painful to move mhmm and literally it feels numb mhmm like my leg feels numb again yeah alright and do you have a weakness on that part of side I've had a weakness I've had weakness since I collapsed 2 2 years ago 2 years okay I've been having physio okay understood I've been that's why I've been a lot lot better until now yeah and then I don't know what happens between me just getting off the bus and me trying to get off to work all of us like literally found myself in the bush awful and I'm thinking to train the bush and it saved me let's just find you on the end monique and see what is going on before is this you wanting to have a row yep I I I feel like I'm I'm disturbing you guys I should just no you're not to carry me don't worry it's all good try try to carry on but my my my colleagues because my arm's getting work I feel like I can't move it mhmm thought I better get get checked out that's good because I wasn't gonna get checked out I was just gonna try to carry on my my shift yeah stroke I'm looking across because my stroke nurse will come down as before and I just want to make sure she's not I'm not ignoring you sorry no just sorry I'm struggling to get more my words and stuff so you see you've seen doctor france yeah I was seeing back in june so a while ago mta clinic like I said up until now I've been fine I've just had the odd I had the flu january other than that I'd be literally fine until now and I touch what I really don't know what's going on like mhmm december I fainted twice mhmm because I had a steroid injection in my shoulder to try to get it moving again moving again I fainted after that but I put it down to the steroid and then the friday of the same week I was coming back from toilet ct and I wiped out and you work in ct normally I work in radiology so we we cover you cover all kinds of things we we cover c ct and mri ultrasound and everything yeah for okay and I just and then that saturday I I came down with the flu really bad so I keep putting all that down into but the but just loud but but this doesn't feel like that doesn't feel like that let me just see if this is my stroke nurse calling me alright it's rob you alright bam yes so well so she's on cpap at the moment and she'll be on it for I was planning to keep her on it for an hour and see how it goes and see whether I wanna make sure that she doesn't go back into type 2 respiratory failure so I'm I was gonna keep her in recess for at least an hour to make sure that she stays stable on cpap I think it's very likely that she'll continue on cpap I think it's likely she'll need an ecu bed I guess there's the possibility that we might be able to get her off it but I think that will take a good few hours so yeah is that all right she's she was on bipap earlier but now she's on cpap and has been for the last 40 minutes that's very kind thank you thanks cheers bye sorry about that good and miss jones you're we're we're really busy no it's fine taking up your time taking up my time I just need do you mind if I do a structured assessment for stroke is that okay yeah it's just the scoring system so I just I'll be looking at my phone and scoring you as I go alright yeah yeah can you can you tell me how old you are 54 lovely sorry I had to work that out and can you tell me what month it is february february lovely can you squeeze my fingers it might be a bit painful okay painful yes in my left hand oh but after you're full yeah and can you blink your eyes that's fine thank you just follow my fingers with your eyes then sorry is it feeling uncomfortable yeah double vision or just double vision what like there's like 4 of them no you poor thing I don't know which 1 to follow and what do you normally take for these migraines when they get wet I've got a whole combination of medication I I did I did did take some I have a pro pro profin about 12:00 trying to help with the pain but it's not making a difference do you take sumatriptan oh lovely so you take omeprazole epicenter what's epicenter valproate fine 150 mg 30 mg of mirtazapine 10 of montelukast 92 22 relvar ellipta inhaler 2.5 mg of birivamycin some salbutamol is this because you have asthma yes I'm I'm severely asthmatic is fine neutrogenicity triggered the collapse 2 years ago so you don't take a huge amount for the for the migraine do you you could try something like a triptan if this is a migraine see if that makes you feel better in terms of your visual fields can you pop your right hand over your right eye is that okay right hand yeah I'm happy to do whichever you want can you see my finger here yeah just about keep looking at my face can you see the finger in can keep can you see it in the corner of your vision no okay and how about here just about mhmm here no and here just about okay it's a bit fuzzy can you see it up here no if you look at it can you see it if I look at it I can see it okay but if I'm staring at you I it's and can you see it here just about it's like I said it's really fuzzy okay tell me when it disappears there and on the other side you yeah okay we've swapped it on that's fine yeah I can't lift this up real quick at the moment sorry no no it's fine can you see it here yeah here yeah here just about now I can now you can but now you can't yeah now I can now I can yeah down here yes lovely let's try can we try the other side again up here can you see it here if I look at it if you look at it and if you keep looking at me when can you see it out there okay and if you stay in the same place when can you see it out there keep looking at me can you see it in the corner of your vision no okay no it's just coming in just coming into you okay that's fine I know is neo a specialist for you guys I I I see I I I I see you're in ct yeah we come to ct a lot do you mind if I tell you a bit about you just so she knows what's going on is that alright this is monique who works in radiology who has been seeing doctor france previously back in june with a diagnosis of fnd as well as chronic migraine you have migraines all the time I take it and then today you left the bus felt your headache was worse I didn't know I didn't feel I didn't feel just fell forward I just fell into the dirt and now have some tingling on the left hand side of my body and so and I don't know how I got down there mhmm yeah I literally it's a complete a complete blank yeah so we're just doing it in a hss and then I think we could treat her for a migraine and see if that makes you feel a bit better alright and then in terms of your visual movements can sorry your facial movements can I see you give me big smile that's fine can you squeeze your eyes very tightly can you lift your eyebrows up that's fine can you put your tongue out that's lovely thank you and then in terms of your arm are able to lift your left arm up for me it's painful is it it's really painful in your shoulder all down in here all down in your arm like in in my shoulder oh jeez that's okay you're able to keep your you'd be able to lift your arm up not to pain but just give it a bit of power for me lovely and keep it in a spot that's not painful for you if you can so keep it in just hold a hold a spot that's not painful that's fine yeah and just keep it up okay and how about the other side how's that is that good that's fine that's fine that's fine you can keep that up for yeah would you hold it up for me for about 10 seconds 1 234567 how about the other side in a nice spot that's not painful just give it a bit of power and keep it up for about 10 seconds 234567 well done you that's great and how about your leg can we see 1 why don't we give you a good leg first better +1 2345 that's wonderful and how about the other side +1 2345 lovely no problem that's fine great can I ask you to do a bit of clapping for me like this that's gonna be painful no I don't want it to be painful what can we do that's not painful for you might you want want to try finger to nose yeah would that be better yeah I don't want it to be painful yeah of course pop your touch your nose and then touch my finger yeah then to my finger then to your nose to my finger to your nose and to my finger yeah lovely that's fine and try with your left hand it's like you yeah I'm not sure where my finger is yeah but you're not past pointing or anything like that like you just don't know where it is I just yeah I can't can't really see it can't focus yeah do you have any disturbance in your vision at all not normally not normally but in the bulb it just even with my glasses I'm sorry if my eyes feel like there's a like a cloud mhmm it's really fuzzy really fuzzy yeah fuzzy don't know why it shouldn't be normally it's quite like I said not not again first not normally I'm quite well and I don't like troubling you guys yeah no don't worry it's fine not normally just plump through through yeah but these sounds like they're serious symptoms aren't they can you feel me touching your head does it feel the same on both sides it feels same a little bit more painful on that side because of what the way I I I I think I lagged it yeah and how about your knees yeah same same not painful good no lovely and then can I ask you to read some of these words is that alright so can you read any of those for ma ma ma ta top 50 50 mhmm thank you just after that's good and can you name any of these objects for me bridge bicycle cloud okay cool so sorry no don't worry it's alright I don't what's know going on that's okay you're safe next I'll just last thing up just for me to tell me which of my you should tell me which of my hands is moving right yeah am I right that's fine yep mhmm and now 0 0 0 okay so there's no intention that's good fine alright I think so in terms of our structure assessment it's not not too bad I think you are having difficulty finding words but not in the pattern that I normally associate with stroke certainly and what you describe certainly isn't in the pattern of what I would normally think of a stroke is that fair to say neos good neos sees a lot of people with stroke way more than I do so that's good think think the best thing is to treat you for this migraine it sounds like it's really severe and causing you a lot of symptoms and I think that can often cause these significant neurological symptoms as well right so should we let's get you lots of treatment for that and get you feeling better okay big dose of aspirin some some triptans for the migraine as well and see if that'll make you feel better okay is that alright yep yep yep great fine brilliant do you have any blood thinners or anything like that I didn't see any on your list of medicines no good so there's no chance you'd be bleeding anything like that no so that's good fine alright yeah we'll get that sorted did you scan out no no no good great I'm glad we'll see how you go with that and if you don't get better we could always scan your head but it seems like a bit of radiation that you don't need if we can avoid it that sound okay I'm I'm I'm I'm oh I'm sorry it must be really frustrating yeah I'm I'm I'm used to them scanning my head mhmm yeah of course I know I bet yeah I saw you'd had a few so I didn't yeah I'll see if we can get you out of the waiting room because it's not very dignified being here in your work uniform in the waiting room I'll do my best to help you thank vacation of course not many people like it to be fair can I give you a hand or you can well I don't know if the nurses wants to do anything need to be clear let me make sure are you allergic to anything oranges and alcohol oranges and alcohol I won't give you either of those you could have some aspirin have you had any aspirin today no no thank you you're welcome shall we x-ray your hand yes I'm gonna make sure there's nothing broken in there if it's sore yeah well you've had some bloods today with your gp how good why didn't you go see them today yesterday yesterday oh they were just reported yesterday just just just a regular medical review got it fine and you didn't have any of these symptoms there like this no no fine lovely you should get an ecg shouldn't you we don't need to do that necessarily now and or flat breasts request that I'll ask the nurse to give you a bit of medicine to make you feel better alright molly yeah sounds good nice to meet you I know you can come and see you why don't you hang out here for a minute and see if the nurse is gonna give you any isn't it it wasn't the same symptoms just in the lymph yes intermittent left sided tissue yeah centralness it wasn't speech to self extension but the speech to self extension has is not throaty it's like no she she was she she spoke and then and then she realized herself and then she started doing it yeah yeah mhmm because when she's saying oh I didn't eat and I think it just happened that was all straight and then we were and then we asked her again and then she started doing it yeah in the morning what's your hand oh thank you they're warm warm I'd like to I'll wait for you we'd left her next door yeah we think it's a migraine and I think she has a background of her food being that it migrates and it affects much I've written her up with some aspirin some sumatriptan yes and some metoclopramide for for her migraine and I've booked an x-ray of her risk of illness I suppose it's more of a more severe sorry otherwise I've left her in there make the drugs out yeah yeah yeah yeah thanks what I didn't know I was on food today they told me I was on study leave because I was training day nice and then so I was like up until midnight yeah just hanging out yeah you know just I was just tapping on my computer oh no you know I was doing a bit of my little stuff you know I like to deal with it it's bit of telling and that sort of thing telling oh no until like midnight and was like was and the training doesn't start till half past 9 0 amazing lying exactly I was hanging out I'm a I was hanging out with iris in the morning lovely we had some breakfast we were just playing until like 4 + 8 0 and the radio coordinator called me I was at home I was like I'm in bed and you're like what and then you're like I got a work what are they going do the long run I do the bus I thought I was gonna be doing like 5 9 to help me work and I was gonna be like 6 to 3 years see now I've got the lunches too though oh that's brilliant because I'm really tired and no will to tired I've been doing a lot of good things these people nothing good I'm not gonna get into this fine I'm gonna have she's already in the process now what what what might muster up for you I just need to go and have a cry in the cup and open have you had some chocolate had a lime bar really good I don't normally have meth today because I like to take them I'm a bit off okay oh you you're busy terrible they're french really a little bit of personally they're french is fucking yeah fancy I'll give them a minute it's like I was like a vegan just having steak for the first time I thought the friendly boyfriend nesta having a lime oh they're bloody good they they're like really fucking real thought you might have gone for a yorkie I guess yeah I like yorkie I'm more of a raisin and biscuit boy myself though oh wow yeah yorkie raisin and biscuit is really good isn't it you can't ever go back to a plain yorkie once you've had that I can't say I've had that that's fine because you're a girl in it well yeah no and when I was younger I wasn't allowed to go the set not for girls because I'm boys chocolate barking voice no fine thank you that's nice isn't it yeah sweet sometimes we're actually nice to meet you they yeah we don't really chat as I look but I like that it's good do you want it no no oh okay sure I don't need to because we always catch up here I mean I'm otherwise we'd have nothing to talk about yeah but it's fabulous I still yeah I don't don't doubt that better outside of it I'm gonna let you go because you're pretty goodies I know what are you like outside of it not that ever wow yeah great and the under view I'm looking for people isn't no did I'm gonna tell you for it you seem to get on well with the rest of the course everybody but not social not that yeah unspecial there's a few outside of bright people that's it we're very lucky very lucky people very lucky rachel being 1 of them rachel of course my god when is she coming back as soon like march when I say march and that's saturday now I don't think it's I remember because I've got eggs in couple's time here's egg I haven't got to hand it down have I no no and you are 3091 wow even though you number that's good I'm impressed by all of this login number I can come back now 308 yeah +1 32 yeah +1 65 thank you how about that oh nice yeah so yeah pretty soon oh exciting I get to see her here that's nice I haven't I haven't really seen her since nct nice because they hang out until baydos sam works a lot yeah you know you know him yeah yeah nice guy yeah it's fun yeah we should go out sometime do little me too fresh no got a child don't we travel exactly basically time currently it's when it gets bit older a little bit more than I am yeah do know what I mean like it's gonna be mouth can say this was gonna look after my own kids let them into my house oh yeah fuck it so but do you yeah well so but we can socialize with with our child and I'll go with the dogs not just and then we'll no 1 will talk to each other because dogs will be that way creator is this that'd be brilliant sounds brilliant yeah it does sound good we can do this and we'll do that with his medical patients you've got here just a hero yeah how are we okay not really what's her oh thank god come in they're struggling yeah yeah yeah you're another 2 in so plan is should include bedtime nursing in bed with ice saw my dinitrate infusion running further furosemide this evening wean off cpap once adequately diaries then able to maintain off cpap bye reluctant to wean now as had significant type 2 respiratory failure on presentation so concerned may recur