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Neurological Assessment of The Suspected Stroke Victim For the

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					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
     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.
   Cincinnati Prehospital Stroke Scale

• Evaluates:
  – Facial Droop
  – Motor Arm Weakness/Arm Drift
  – Speech Abnormalities
   Cincinnati Prehospital Stroke Scale

• 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.
Cincinnati Prehospital Stroke Scale


   Any abnormal score, in any of the
  three areas assessed are considered
   positive for Acute Stroke or TIA.
Los Angeles Prehospital Stroke Screen
             (LAPSS)
    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.
   Los Angeles Prehospital Stroke Screen
                (LAPSS)

• Evaluates:
  –   Age
  –   History of Seizures/Epilepsy
  –   Duration of Symptoms
  –   Evaluation of Status before Symptom Onset
  –   Glucose Level
  –   Physical Assessment
   Los Angeles Prehospital Stroke Screen
                (LAPSS)

• Age < 45 Years Old
  – Yes
  – No
  – Unknown
   Los Angeles Prehospital Stroke Screen
                (LAPSS)

• History of Seizures or Epilepsy ABSENT
  – Yes
  – No
  – Unknown
   Los Angeles Prehospital Stroke Screen
                (LAPSS)

• Symptom Duration < 24 Hours
  – Yes
  – No
  – Unknown
   Los Angeles Prehospital Stroke Screen
                (LAPSS)

• At baseline, Patient is NOT wheelchair
  bound or bedridden.
  – Yes
  – No
  – Unknown
   Los Angeles Prehospital Stroke Screen
                (LAPSS)

• Blood Glucose between 60 and 400mg%dL
  – Yes
  – No
  – Unknown
   Los Angeles Prehospital Stroke Screen
                (LAPSS)

• 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
Los Angeles Prehospital Stroke Screen
             (LAPSS)


 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.

				
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posted:10/2/2011
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