Demo

Section 5 -MEDICAL

5.04 SUSPECTED STROKE/TRANSCIENT ISCHEMIC ATTACK (T.I.A.)

PRINCIPLES

• Rapidly identify patients with suspected stroke
• Minimize scene time & safe, expediate transport to the appropriate facility
• Continuous review and improvement on the stroke management process
• INITIAL MEDICAL CARE 2.01
• Differential Diagnosis
  • ALTERED MENTAL STATUS (AMS) 5.03
  • SEPSIS 5.17
• Establish a definitive last known well (LKW) time
• Complete a Cincinnati Pre-Hospital Stroke Exam

Cincinnati Pre-hospital Stroke Exam (amended)

• Cincinnati and VAN assessments can be performed simultaneously

Face

Arm

(VAN Positive or Negative?)

Speech

(VAN Aphasic? Consider VAN Visual Disturbance and Neglect!)

Time

Differential Diagnosis 5.03 ALTERED MENTAL STATUS (AMS) 5.17 SEPSIS BLOOD GLUCOSE

STROKE CHECKLIST Identify any t-PA exclusions and document all findings 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.

IV ACCESS: an 18 gauge is preferable. Avoid multiple attempts and IO's 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. Notify ER staff and document location of any missed IV’s. ** Be conscientious of numerous IV attempts due to possibility of Fibrinolytic therapy and subsequent bleeding from both successful and attempted IV sites. HYPERTENSION Do not treat hypertension

ELEVATE THE HEAD OF THE STRETCHER 15-30degrees if systolic BP >100 mm Hg Do not allow aspiration -Maintain head and neck in neutral alignment, without flexing the neck -Protect paralyzed limbs from injury -Obtain 12-lead EKG -Nausea/vomiting - administer an antiemetic

Have Patient hold both arms up for 10 seconds Is arm weakness present? YES continue VAN assessment NO Patient is VAN negative.

Visual

Aphasia

Neglect

   ARM DRIFT PLUS ONE OF THE ABOVE IS VAN POSITIVE

Cincinnati and VAN assessments often are performed simultaneously TRANSPORT DESTINATION (Determined ONLY by VAN Assessment Results) Symptoms 5 minutes to >5 days called in as STROKE ALERT Stroke receiving center can determine acuity and level of aggressive action.

Transporting EMERGENCY or NON-EMERGENCY is determined by the crew but <24 hours of LKW is recommended EMERGENCY transportation.

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.

COMPREHENSIVE STROKE DESTINATIONS: Evaluation of suspected Large Vessel Occlusion (LVO) -or- Have contraindications for IV therapy such as Coumadin therapy, recent surgery, treatment of bleeding ulcer, etc.

Advent Health Orlando - Comprehensive Stroke Care Orlando Regional Medical Center - Comprehensive Stroke Care

PRIMARY STROKE DESTINATIONS: All suspected stroke and TIA patients must be transported to a stroke-receiving facility, unless the patient is UNSTABLE. The following hospitals have been approved by the Medical Director: Advent Health Altamonte - Primary Stroke Care Advent Health Apopka - Primary Stroke Care Advent Health East - Primary Stroke Care Central Florida Regional Hospital - Primary Stroke Care Orlando Regional Medical Center - Comprehensive Stroke Care Oviedo Medical Center - Primary Stroke Care South Seminole Community Hospital - Primary Stroke Care Advent Health Orlando - Comprehensive Stroke Care Winter Park Memorial Hospital - Primary Stroke Care