neurological emergencies study notes

Neurological Assessment of The Suspected Stroke Victim For the

EMT-B

Objectives

• Discuss the importance of prehospital stroke assessment

• Describe the importance of organized stroke management protocols

• Discuss components of Cincinnati Prehospital Stroke Scale and the Los Angeles Prehospital Stroke Screen

• Identify key components of prehospital stroke management

Importance of Prehospital Stroke Assessment

It is imperative for systems to utilize a consistent method to assess possible

stroke victims. If a system is well organized and consistent then the

results from these assessments will determine the best facility to care for

the emergent stroke victim.

Importance of Prehospital Stroke Assessment

• If a system chooses one method of assessment it will promote consistency and continuity of care with receiving institutions.

• This consistency will enhance communication with the hospital and physicians who will be caring for the patient.

Organized Stroke Management Protocols

A protocol, or Standing Order, provides a consistent format for the evaluation and

treatment of patients. In the case of Stroke victims protocols will ensure that they are

assessed and treated by EMS and then transported to the correct facility to meet

their needs. Treatment may include medication administration, surgery or

basic observation.

Cincinnati Prehospital Stroke Scale


• Developed in Cincinnati, Ohio.

• Evaluates 3 major physical findings.

• It is a brief and condensed exam.

• Minimizes prehospital delays.

• Enables prearrival notification of the receiving facility.


• Evaluates:– Facial Droop– Motor Arm Weakness/Arm Drift– Speech Abnormalities


• Brief exam. Can be accomplished in 60 seconds or less.

• Does not require any special equipment to perform the exam.

• Simple exam which is scored as either:– Normal– Abnormal

Areas Assessed

• Facial Droop: Have patient show teeth or smile.

– Normal: Both sides of the face move equally well with no droop noted.

– Abnormal: One side of face does not move as well as the other side.

Areas Assessed

• Arm Drift: Have patient close eyes and hold out both arms in front of them.

– Normal: Both arms move the same or both arms do not move from their extended position.

– Abnormal: One arm does not move or one arm drifts down compared with the other.

Areas Assessed

• Speech: Have the patient say “you can’t teach an old dog new tricks.”

– Normal: Patient uses correct words with no slurring.

– Abnormal: Patient slurs words, uses inappropriate words, or is unable to speak.


Any abnormal score, in any of the three areas assessed are considered positive for Acute Stroke or TIA.

Los Angeles Prehospital Stroke Screen(LAPSS)


• More detailed than the Cincinnati Prehospital Stroke Scale.

• Statistically more likely to diagnose a stroke.• 3 to 7% likelihood that a patient may be suffering

a Stroke/TIA even if ruled out by LAPSS.• Requires that blood glucose monitoring or

dextrostix be performed as part of the assessment.


• Evaluates:– Age– History of Seizures/Epilepsy– Duration of Symptoms– Evaluation of Status before Symptom Onset– Glucose Level– Physical Assessment


• Age < 45 Years Old– Yes– No – Unknown


• History of Seizures or Epilepsy ABSENT– Yes– No– Unknown


• Symptom Duration < 24 Hours– Yes– No– Unknown


• At baseline, Patient is NOT wheelchair bound or bedridden.– Yes– No– Unknown


• Blood Glucose between 60 and 400mg%dL– Yes– No– Unknown


• Facial Smile/Grimace: – Equal or R/L sided facial droop

• Grip– R/L sided weak grip or no grip

• Arm Strength– R/L sided downward drift


Patients are considered positive for Stroke/TIA if they score a Yes or Unknown on the first 5 categories

and have a deficit on any portion of the physical assessment.

Key Components of Prehospital Treatment for Stroke/TIA

Victims

Prehospital Treatment

• Airway Management– At risk for apnea– At risk for aspiration

• Oxygen Therapy• Shock Management

– Hypotension is very detrimental for victims of Stroke

• Prevention of Injury– Patients are risk for injury since they may have

decreased sensation and motor function in effected extremities

Prehospital Treatment

• Short Scene Times– With the exception of the previously mentioned

treatments, Strokes are best cared for in a hospital. Decrease scene times when appropriate.

– Care at the Appropriate Facility– Some patients who suffer Strokes may benefit from clot

busting drugs. They must be given during a very short window of time following onset of symptoms. Other patients may benefit from surgical intervention. This requires that a patient be transported to a facility which can perform Neurological Surgery.

One Very Important Factor

Many of the therapies that are employed in the treatment of Stroke Victims are time

sensitive. We as EMS personnel must try to isolate the time of onset of symptoms. If a patient awakens with symptoms or is

found unresponsive Physicians will assume that the symptoms occurred when they first

went to bed or when they were last seen.

Stroke Treatment

Stroke victims will benefit most by an organized system of assessment and treatment. EMS and Hospitals

must work together for the patient to receive the best possible care.

neurological emergencies study notes

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