Suspected Stroke Transcient Ischemic Attack TIA
Section 5 -MEDICAL
5.04 SUSPECTED STROKE/TRANSCIENT ISCHEMIC ATTACK (T.I.A.)
- Perform Cincinnati Pre-hospital Stroke Exam
- Facial smile/grimace – Ask patient to show teeth or smile.
- Arm drift – close eyes and hold out arms for count of 5
- Speech – “You can’t teach an old dog new tricks.”
- Determine - LAST TIME SEEN NORMAL
- If altered sensorium, refer to ALTERED MENTAL STATUS PRACTICE PARAMETER (5.03).
- Administer D50 with BGL ≤ 50,
- Consider a half-dose of D50 if BGL < 100 AND > 50. Re-check BGL. If seizure activity present, refer to SEIZURE PRACTICE PARAMETER (5.12).
STROKE-ALERT SCREENING PROCESS
- Perform MEND* exam on scene, using the Stroke Alert Checklist
- Identify any t-PA exclusions and document all findings
- Begin immediate transport and initiate a “STROKE ALERT” if:
- Patient has signs & symptoms consistent with stroke or T.I.A.
- LAST TIME SEEN NORMAL is < 3.5 hours and patient does not meet criteria for intra-arterial therapy
- If IV is obtained, it should be at least an 18 gauge. Avoid multiple attempts and IO's
STROKE-RECEIVING DESTINATIONS: All suspected stroke and T.I.A. patients must be transported to a stroke-receiving facility, unless the patient is UNSTABLE. The following hospitals have been approved by the Medical Director:
- Florida Hospital Altamonte – Primary Stroke Care
- Florida Hospital East – Primary Stroke Care
- Central Florida Regional Hospital – Primary Stroke Care
- Orlando Regional Medical Center – Comprehensive Stroke Care and Neurosurgery
- South Seminole Community Hospital – Primary Stroke Care
- Florida Hospital Orlando – Comprehensive Stroke Care with 24/7 Interventional Radiology (IR) services and Neurosurgery. (revised 5.19.10)
- Winter Park Memorial Hospital - Primary Stroke Care (revised 1/25/2017)
EVALUATION FOR INTRA-ARTERIAL THERAPY OR LARGE VESSEL OCCLUSION Patients presenting with the following neurological findings shall be transported directly to FLORIDA HOSPITAL ORLANDO OR ORLANDO REGIONAL MEDICAL CENTER:
- Severe hemiparesis or hemiplegia, (inability to lift or hold arm up) AND
- Dysconjugate gaze, forced or crossed gaze, (if patient is unable to voluntarily respond to exam, perform Doll’s eye test) AND
- Last seen normal greater than 3 ½ hours ago but less than approximately 12 hours OR
- Have contraindications for IV therapy such as Coumadin therapy, recent surgery, treatment of bleeding ulcer, etc.
- If greater than 12-hours, a “STROKE ALERT” is not indicated. Use normal radio protocol and transport to the nearest stroke-receiving facility.
- Use of air medical resources is appropriate when the window for evaluation for Intra-arterial therapy is less than 1-hour and ground transport exceeds 30 minutes.
- Do NOT treat hypertension
- Do not allow aspiration - elevate head of stretcher 15 - 30 degrees if systolic BP >100 mm Hg
- Maintain head and neck in neutral alignment, without flexing the neck
- Protect paralyzed limbs from injury
- IV Normal Saline (avoid multiple IV attempts)
- Perform blood draw of all tubes. The crew shall hold onto the tubes at the hospital until a staff member is ready to label the blood tubes. Document that blood was drawn.
- Obtain BGL
- Obtain 12-lead EKG
- Nausea/vomiting - administer an antiemetic
- Complete Stroke Checklist and leave copy at hospital.
- Forward or Fax the duplicate Stroke Checklist to County EMS QA office.
- A copy of the completed stroke checklist must also accompany the abbreviated report for the agency.
Miami Emergency Neurologic Deficit
- Do not delay transport since definitive care for the restoration of neurologic function may be significantly improved with timely treatment at receiving facility.
- Be conscientious of numerous IV attempts due to possibility of Fibrinolytic therapy and subsequent bleeding from both successful and attempted IV sites. Notify staff and document location of any missed IV’s. **Do not use IO unless the patient needs immediate treatment.