What is the appropriate SAMPLE (Signs/Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events) history for a patient presenting with stroke?

SAMPLE History in Stroke Patients

The SAMPLE mnemonic is a prehospital and emergency assessment tool, but for stroke patients, the critical historical elements differ significantly from standard SAMPLE application—time of symptom onset is paramount, followed by medication history (especially anticoagulants/antiplatelets), and recent medical events that would contraindicate thrombolysis.

Critical Historical Elements for Stroke Assessment

S - Signs/Symptoms (Time of Onset is MOST Critical)

The single most important piece of information is determining when the patient was last known to be at baseline or symptom-free 1, 2. This defines treatment eligibility:

• For patients awake at onset: Document the exact time symptoms began
• For "wake-up" strokes: Use the time the patient was last known to be symptom-free before sleep 1
• For fluctuating symptoms: If mild symptoms worsened, use the time of first symptom onset 1
• For recurrent events: If symptoms completely resolved (TIA) then recurred, use the time of new symptom onset 1

Creative time anchoring strategies 2:

• Cell phone call timestamps
• Television program times
• Last bathroom/kitchen visit for wake-up strokes

Document specific neurological symptoms:

• Focal deficits (unilateral weakness, speech difficulties, vision changes)
• Level of consciousness
• Presence of headache, vomiting (suggests hemorrhage) 1

A - Allergies

While standard allergy history is obtained, this is less critical in acute stroke management compared to other SAMPLE elements.

M - Medications (CRITICAL for Treatment Decisions)

Query specifically about 1, 3, 1:

• Oral anticoagulants (warfarin, DOACs) - absolute contraindication consideration for thrombolysis
• Injectable anticoagulants (heparin, LMWH)
• Antiplatelet agents (aspirin, clopidogrel)
• Antihypertensive medications
• Bring medication containers or obtain medication list 3

P - Past Medical History (Focus on Thrombolysis Contraindications)

Essential recent events to document 1:

• Recent trauma or surgery (within 3 months)
• Recent hemorrhage (GI, GU)
• Recent myocardial infarction
• Previous stroke or TIA
• History of intracranial hemorrhage
• Known brain tumor or vascular malformation
• Recent arterial puncture at non-compressible site

Chronic conditions:

• Diabetes (glucose >170 mg/dL in non-diabetics suggests hemorrhage) 1
• Hypertension
• Atrial fibrillation
• Seizure disorder

L - Last Oral Intake

Document last oral intake for:

• Aspiration risk assessment
• Potential procedural sedation planning
• Dysphagia screening will be performed before any oral intake 4, 5

Critical caveat: Do NOT give anything by mouth until dysphagia screening is completed 4, 5, 6.

E - Events Leading to Stroke

Circumstances surrounding symptom onset 2:

• Activity at time of onset
• Witnessed seizure activity (stroke mimic)
• Recent infection or fever
• Drug use
• Pregnancy status
• Trauma related to current event

Additional Critical Assessment Components

Vital Signs (Provide Diagnostic and Prognostic Clues)

1:

• Blood pressure: SBP >220 mmHg suggests hemorrhage risk 1
• Heart rhythm: Irregular rhythm suggests atrial fibrillation
• Temperature: Fever may indicate infectious cause or complication
• Oxygen saturation and respiratory pattern

Obtain History from Alternative Sources

If patient is confused, aphasic, or unconscious 1:

• Family members
• Friends
• EMS personnel
• Coworkers, neighbors, apartment managers
• Obtain phone numbers of witnesses 3
• Transport witnesses with patient if possible 3

Common Pitfalls to Avoid

1. Accepting vague onset times: Push for specific time anchors rather than approximations
2. Missing anticoagulant use: Specifically ask about all blood thinners, not just "medications"
3. Delaying assessment for complete history: Time is brain—obtain critical elements (onset time, medications, contraindications) immediately while other team members prepare for imaging
4. Giving oral medications/food before dysphagia screening: This significantly increases aspiration risk 4, 5

The stroke-specific history prioritizes treatment eligibility determination over comprehensive medical documentation—focus on onset time, anticoagulation status, and thrombolysis contraindications first 1, 3, 2.