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Dyspnea is a common symptom in ED patients contributing substantially to ED, hospital, and ICU workload. It is also associated with significant mortality. There are a wide variety of causes however chronic disease accounts for a large proportion.

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Objective: To assess efficacy and safety of a 24‐hour comprehensive protocol‐driven model for rapid assessment and thrombolysis of stroke patients in the emergency department. Design: Prospective open observational study. Participants and setting: All patients with acute stroke presenting within 3 hours to the St Vincent's Hospital (Sydney) emergency department between 1 December 2004 and 30 July 2005. Main outcome measures: Proportion of patients treated, patient demographics, clinical outcome, adverse events and time to treatment parameters. Results: 134 patients (100 stroke; 34 transient ischaemic attack) were admitted to the stroke unit during the study period. Of the 100 stroke patients, 40 presented within 3 hours of symptom onset. Fifteen patients had no contraindications and received intravenous thrombolysis. At 3 months, 10 patients (67%) were independent (modified Rankin score [mRS], 0–2) and seven (47%) had an excellent functional outcome (mRS ≤ 1). Symptomatic intracranial haemorrhage was not observed. The median time from symptom onset to tissue plasminogen activator treatment was 155 minutes (range, 105–197 min). Median onset‐to‐door, door‐to‐computed tomography, and door‐to‐needle times were 48, 25, and 87 minutes, respectively. Conclusion: Rapid assessment of stroke in the emergency department according to a comprehensive protocol allows identification and treatment of acute ischaemic stroke patients eligible for thrombolysis.

'Out of hours' NCHCT scan interpretation by senior ED medical staff is only correct two-thirds of the time. Further education for all senior ED staff is indicated to improve our accuracy. The safety of NCHCT scan interpretation by senior ED medical staff needs further study.