SIM Scenario Exchange

Acute Stroke on the Ward

Contributed on May 13, 2021, last updated July 20, 2022.



Alim Nagji, MD CCFP-EM DRCPSC (Clin.Ed.), McMaster University / Joseph Brant Hospital
Anum Haroon, MD CCFP, Oakville-Trafalgar Memorial Hospital

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A 74 year old female is admitted under the hospitalist at a community hospital with a UTI. She is on day 3 of antibiotic therapy. While in hospital, she develops acute onset of right arm weakness, facial droop and unintelligible speech. Participants should recognize an acute CVA within the window, perform a stroke assessment, treat hypertension and administer TPA and consider thrombectomy.
This case can be performed by hospitalists, internists, intensivists or in situations where ED doctors are called to the floor. The time of day can also be modified to after hours to emphasize how local protocols may differ at various points of the day. In this case, no in hospital neurologist is available and the hospital is not a stroke centre.

Learning Objectives:

Identify and activate the Code Stroke (Teal) protocol for an acute stroke within the window
Perform a National Institute of Health Stroke Scale
Demonstrate understanding of indications and contraindications for the administration of recombinant tissue plasminogen activator (TPA)
Recognize different imaging modalities for stroke diagnosis and demonstrate knowledge of indications for mechanical thrombectomy

Simulation Modality:

Manikin-based, Role-playing


TPA contraindications check list Glucometer IV lines Oxygen mannekin or actor


This scenario was created as a collaboration between Joseph Brant Hospital and Oakville-Trafalgar Memorial Hospital, two community hospitals that deal with stroke patients on wards. In community sites, a number of different specialties may be responsible for acute stroke activations which can take place in the ED, on a medical ward or in the Intensive care unit. This scenario was piloted with a group of hospitalists to pilot a new code stroke protocol and review advances in mechanical thrombectomy including regional referral practices.
8 hospitalists participated in the sim and feedback on the scenario was integrated into the case design.


Nagji A, Haroon A. Acute Stroke on the Ward. Simulation resource published by Simulation Canada; 2021. Available from

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Target Learners






Continuing professional development
Graduate / postgraduate / residency
Undergraduate / post-secondary

Fields / Disciplines:

Critical care
Emergency / trauma

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