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).
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]).
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]
The alternative acronym 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)
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
^ a b"Stroke Warning Signs and Symptoms". www.strokeassociation.org. Retrieved 2017-01-03.
^Saver Jeffrey L. (2006-01-01). "Time Is Brain—Quantified". Stroke. 37 (1): 263–266. doi:10.1161/01.STR.0000196957.55928.ab. PMID 16339467.
^Harbison, Joseph; Hossain, Omar; Jenkinson, Damian; Davis, John; Louw, Stephen J.; Ford, Gary A. (January 1, 2003). "Diagnostic Accuracy of Stroke Referrals From Primary Care, Emergency Room Physicians, and Ambulance Staff Using the Face Arm Speech Test". Stroke. 34 (1): 71–76. doi:10.1161/01.STR.0000044170.46643.5E. PMID 12511753.
^Harbison Joseph; Hossain Omar; Jenkinson Damian; Davis John; Louw Stephen J.; Ford Gary A. (2003-01-01). "Diagnostic Accuracy of Stroke Referrals From Primary Care, Emergency Room Physicians, and Ambulance Staff Using the Face Arm Speech Test". Stroke. 34 (1): 71–76. doi:10.1161/01.STR.0000044170.46643.5E. PMID 12511753.
^ a bAroor Sushanth; Singh Rajpreet; Goldstein Larry B. (2017-02-01). "BE-FAST (Balance, Eyes, Face, Arm, Speech, Time)". Stroke. 48 (2): 479–481. doi:10.1161/STROKEAHA.116.015169. PMID 28082668.
^Pickham, David; Valdez, André; Demeestere, Jelle; Lemmens, Robin; Diaz, Linda; Hopper, Sherril; de la Cuesta, Karen; Rackover, Fannie; Miller, Kenneth; Lansberg, Maarten G. (March 2019). "Prognostic Value of BEFAST vs. FAST to Identify Stroke in a Prehospital Setting". Prehospital Emergency Care. 23 (2): 195–200. doi:10.1080/10903127.2018.1490837. ISSN 1545-0066. PMID 30118372.
^Tran, D.S. (2017). NEWFAST: A New Stroke Identification Tool. [Poster]. AANN Stroke conference. Chicago, IL
^"Stroke Symptoms: From FAST to FASTER". www.beaumont.org. Retrieved 2021-03-11.
