FAST
Stroke Recognition
Time is brain. 🧠 Every minute lost = 1.9 million neurons.
Clinicians lean on this acronym when the question is whether to call a stroke alert from a phone triage or a waiting-room presentation. FAST — Face droop, Arm drift, Speech change, Time to call 911 — is the public-facing screen taught to laypeople and used in EMS dispatch. The AANP exam still asks about FAST because it captures most anterior circulation strokes and emphasizes the time-since-last-known-well, which drives thrombolytic eligibility (under 4.5 hours) and thrombectomy windows (up to 24 hours selected). Use BE FAST clinically, but recognize FAST when it appears in a board vignette and don't overthink the answer.
- FFacial droopingAsk the patient to smile — asymmetry is the sign.
- AArm driftArms out in front, eyes closed — one arm drifts down or pronates.
- SSpeechSlurred, word-finding difficulty, or can''t repeat a sentence (e.g., ''the sky is blue in Cincinnati'').
- TTimeNote last-known-well time; call EMS immediately.
Clinical Context
Community and bedside tool for stroke recognition. Any positive sign = activate the stroke protocol. Imaging (non-contrast CT) first, then decision on tPA (4.5 hour window from onset) or thrombectomy (up to 24 hours for large vessel occlusion).
The "T" also reminds you that "last known well" — not when symptoms were noticed — is what clocks the treatment window. A patient who woke up with symptoms is clocked to when they went to bed. BE-FAST extends the mnemonic with Balance and Eyes (posterior-circulation signs) that classic FAST misses.
Related Mnemonics
- ABCD² — TIA Stroke Risk (ABCD² Score)
- AEIOU-TIPS — Causes of Altered Mental Status
- BE FAST — Stroke Recognition (Extended)
- CAM — Delirium Diagnosis (Confusion Assessment Method)
- Mini-Cog — Brief Cognitive Screen (Geriatric)
Sources
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