Stroke

Question 1

Initial Stroke Screen

Answer 1

• Facial Droop
• Abnormal Speech (Slurred or Incorrect words)
• Arm Drift

Question 2

Pertinent HX

Answer 2

• Hypertension
• Stroke
• Diabetes
• Blood thinners (and time last taken)
• BP meds
• Afib

Last known well time

Question 3

Differential Diagnosis..

Answer 3

• ETOH/Drug usage
• Hypoglycemia
• Head Injury

Question 4

Initial Actions

Answer 4

• Perform Stroke Screen

IF POSITIVE

• Determined “Last Known Well” time w/in 24 hrs

Question 5

If symptom onset <4 hrs..

Answer 5

Transport to a Comprehensive and
Primary+ Stroke Center:
- Banner Main
- TMC
- SJH
- SMH

All Stroke Pt must be Transported to any of these facilities

Question 6

If symptom onset >4 hrs..

Answer 6

Assess for Unilateral Motor Weakness (for 10 seconds)

If weakness is present,
perform VAN screening

Question 7

VAN Screening Assesses..

Answer 7

• Vision
• Aphasia
• Neglect

Question 8

V..

Answer 8

Vision
- Provider holds 2 fingers to the right & one to the left while the Pt stares @ the provider’s nose/mouth.
(left and right visual fields)

Can patient correctly identify the number of fingers on both sides?

• Ask the Pt to look left & right one or more times. (Double vision, equal eye movements)

Do both eyes move at the same speed and direction ?

Question 9

A..

Answer 9

Aphasia
- Show the Pt 2 common objects (pen, shirt) & Ask Pt to verbally identify.

Can patient verbally correctly identify both objects?

Question 10

N…

Answer 10

Neglect
- Ask the Pt to follow your finger with only their eyes form left to right. (forced gaze, inability to track)

Can patient track your finger?

• Ask the Pt to close their eyes with arms by their side. Begin brushing patient’s forearms simultaneously and ask “which arm am I touching?” (equal arm sensation)

Can patient feel both arms at the same time?

• Observe if the gaze turns to one side or does not react to stimuli on one side.

Can patient look, move, and react to stimuli on both sides?

Question 11

If “NO” was answered @ anytime during the VAN screen..

Answer 11

Notify receiving facility of “stroke alert” with positive VAN

Question 12

Final Actions

Answer 12

Obtain:
- FSBG & 12 Lead ekg
- “Last Known Well” Time, Emergency Contact, List of Pertinent Meds
- Pt’s Weight
- 18g IV Access
- Notify Receiving Hospital

Question 13

What Should the Meds Relay include?

Answer 13

• Stroke Alert
• If VAN positive
• “Last Seen Well” Time