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

 

 

 

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

 

 

  • Obtain R.A.C.E Score and notify the receiving facility as soon as possible of the Stroke alert.

 

R.A.C.E. Score < 4

 

  • Transport to Primary Stroke Center (PSC) or Comprehensive Stroke Center (CSC)

 

AEMT

  • Draw labs if time permits

 

R.A.C.E Score ≥ 4

 

  • Transport to Comprehensive Stroke Center (CSC)

 

 

 

  • Consider Rapid Sequence Intubation

 

PEARLS:

 

  • Stroke Alert Activation: involves onset of symptoms <4 1/2 hours with a R.A.C.E score of < 4 and within 24 hours with any R.A.C.E score ≥ 4.
  • Comprehensive Stroke Center (CSC): Greenville Memorial Medical Center.
  • Primary Stroke Center (PSC): St. Francis Downtown, St. Francis Eastside, Greer Memorial, and Pelham Medical Center.
  • Before transport, if the patient or patient's family request the patient to be taken to a particular hospital that is not a stroke center, then follow their wishes and document their refusal or recommendations in the PCR.
  • All patients with new signs and symptoms of a stroke regardless of time onset are to be transported to a cardiac/stroke center
  • 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). complete R.A.C.E score on all postive stroke screens.
  • 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.

NREMR

NREMT

AEMT

NRP

NREMT