Stroke/CVA/TIA

 

History:

 

  • Previous CVA/TIA
  • Previous cardiac/vascular surgery
  • Associated diseases
  • Diabetes
  • Hypertension
  • CAD
  • Atrial fibrillation
  • Medications (blood thinners)
  • History of trauma

 

Significant Findings:

 

  • Altered mental status
  • Weakness/paralysis
  • Blindness or other sensory loss
  • Aphasia/dysarthria
  • Syncope
  • Vertigo/dizziness
  • Vomiting
  • Headache
  • Seizures
  • Respiratory pattern change
  • Hypertension/hypotension

 

Differential:

 

  • Altered mental status
  • TIA
  • Seizure
  • Hypoglycemia
  • Tumor
  • Trauma
  • Todd’s paralysis
  • Stroke
  • Thrombotic or Embolic (~85%)
  • Hemorrhagic (~15%)
  • Dialysis/renal failure

 

Perform both Glasgow Coma Scale and Cincinnati Stroke Scale on patients who present with signs/symptoms of stroke.

 

Treatment:

 

 

 

  • Oxygen

 

 

 

  • 12-Lead EKG
  • Obtain BGL
  • Notify the receiving facility as soon as possible of the Stroke Alert

 

 

 

  • Initiate IV
  • establish 2nd IV enroute if time permits

 

 

Acute Stroke (< 4.5 hrs.)

 

  • Yes

 

 

 

  • Draw labs if transporting to GMH and time permits

 

Major Stroke (Altered LOC)

 

  • Yes

 

 

 

  • Consider Rapid Sequence Intubation
  • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • Acute Stroke involves onset of symptoms <4 1/2 hours.
  • Major Stroke involves patient with an altered level of consciousness.
  • All patients with new signs and symptoms of a stroke regardless of time onset are to be transported to a cardiac/stroke center
    • Greenville Memorial Medical Center or
    • St. Francis Hospital Downtown or
    • St. Franics Hospital Eastside.
  • Minimize scene time to 15 minutes.
  • Onset of symptoms is defined as the last witnessed time the patient was symptom free (i.e., awakening with stroke symptoms would be defined as an onset time of the previous night when patient was symptom free).
  • The differential listed on the Altered Mental Status Protocol should also be considered.
  • Elevated blood pressure is commonly present with stroke.
  • Be alert for airway problems (i.e., swallowing difficulty, vomiting, aspiration).
  • Hypoglycemia can present as a localized neurologic deficit, especially in the elderly.
  • Document the stroke screen results in the patient care report (PCR).
  • Document the 12-Lead EKG as a procedure in the PCR.
  • Todd's Paralysis is focal weakness in a part of the body after a seizure. This weakness typically affects appendages and is localized to either the left or right side of the body. It may also affect speech, eye position (gaze), or vision.  It usually subsides completely within 48 hours.
  • Transport to appropriate stroke center.

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic