pre-hospital care in stroke todd j. crocco, md director division of ems university of cincinnati...
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Pre-hospital Care In StrokePre-hospital Care In Stroke
Todd J. Crocco, MDTodd J. Crocco, MD
DirectorDirectorDivision of EMSDivision of EMS
University of CincinnatiUniversity of CincinnatiCincinnati, OHCincinnati, OH
Todd Crocco, MD
Stroke ChainStroke Chainof Survival & Recoveryof Survival & Recovery
• Detection
• Dispatch
• Delivery
• Door
• Data
• Decision
• Drug
Todd Crocco, MD
Prehospital Stroke SurveyPrehospital Stroke Survey
• Findings from a nationwide survey of paramedics and advanced EMTs:–TIA awareness is lacking
–Many felt strokes could be managed non-emergently
–Less than half were aware of the 3-hour time window
Crocco, PEC, 1999
Todd Crocco, MD
EMS Evaluation of Acute StrokeEMS Evaluation of Acute Stroke
• Paramedic diagnosis of stroke/TIA correct in 72% of cases
• EMS dispatchers correctly identify stroke/TIA in 52% of cases
• ED evaluation and CT scan times shorter for ALS vs. BLS responses
Kothari, Stroke, 1995
Todd Crocco, MD
The True Time of OnsetThe True Time of Onset
• Multiple sources– Friends, family, bystanders– EMS has unique opportunities to discover
time of onset
• Times of reference– The time the basketball game started
• How normal were they?– Some patients will have previous neurologic
deficits
Todd Crocco, MD
Prehospital Stroke AssessmentPrehospital Stroke Assessment
• Cincinnati Prehospital Stroke Scale
• Los Angeles Prehospital Stroke Scale
Todd Crocco, MD
The Impact Of 911The Impact Of 911
0
50100
150200
250300
350400
911 Private MD Hospital
First Contact
Time from Symptom Onset to ED Arrival (Mins)
Mean
Median
Barsan, Arch Int Med, 1993
Todd Crocco, MD
Managing The Acute Stroke PatientManaging The Acute Stroke Patient
• Airway, Breathing, Circulation• Assess vital signs• Neurologic exam• Check serum blood sugar• Determine time of onset• En route: IV, O2, monitor• Notify the ED quickly• Transport as soon as possible
Todd Crocco, MD
And Remember…And Remember…
• Do not delay transport
• Do not give large volumes of fluid (unless patient in shock)
• Do not give dextrose (unless hypoglycemic)
• Do not lower blood pressure
• Do not forget to determine time of onset
Todd Crocco, MD
Stroke Treatment in 2000Stroke Treatment in 2000
• Increased public education
• Development of protocols and teams
• Pivotal and expanding role of prehospital care
Todd Crocco, MD
Stroke SummaryStroke Summary
• EMS personnel deserve more stroke education
• Always determine the time of onset
• Call early, transfer immediately
• Stroke is an EMERGENCY!