Stroke

Question 1

Definition

Answer 1

Sudden non-traumatic vascular insult to the brain. May be ischemic (embolic) or haemorrhagic (spontaneous bleeding)

Question 2

Goal of Care

Answer 2

Identify reversible conditions, timely scene management and transport

Question 3

Causes of CVA

Answer 3

• most common - ischemic (plaque or clot)

- spontaneous / hemorrhagic

Question 4

TIAs

Answer 4

TIA (Transient Ischemic Attack) is a dramatic warning that the pt is at risk for stroke within days

It can be thought of as the neurological equivalent to unstable angina in the cardiovascular system

(often referred to as a “warning stroke”)

Question 5

Conditions presenting w/ stroke like symptoms

Answer 5

Any condition that decreases blood flow to the brain

• symptomatic arrhythmia hypotension from GI bleeding or trauma
• hypoglycemia
• seizure disorders

Question 6

Guiding Principles

Answer 6

Accurate recognition, timely scene management, transport, and notification are key principles in caring for stroke pts

Recognition - vital to determine the time of onset for symptoms - if not “last seen normal time” or woke up w/ symptoms

Timely transport - check BGL and correct before initiating transport
preferentially transported to emerge w/ CT imaging

Notify - at least 15mins to activate EVT (endovascular therapy)

Question 7

Hot Stroke Definition

Answer 7

• Screen for stroke using the FAST-VAN tool
• Time since onset is less than 6 hours
  or pt woke up w/ symptoms

Document finding and time of onset on the pt care record

Question 8

Special Notes

Answer 8

• a pt may test normal on the FAST exam and still be having a stroke
  (e. g c/o vision loss in both eyes affecting only part of their vision)
• If a pt is on Coumadin, inform the treating physician immediately on arrival
  the “thinness” of the blood (INR) is an important component in determining the treatment

Question 9

Intervention Guidelines

Answer 9

EMR

• position pt
• supp O2
• IPPV if required
• Assess stroke symptoms
  FAST VAN tool
• Correct hypoglycemia
  Glucogel 1 package
• Ascertain onset or “last seen normal” time
• Minimize scene time
• Facilitate transport w/ notifications

PCP 
- FRONTIER trial enrollment, if indicated
- Correct hypoglycemia
    Glucagon 1mg IM
    Dextrose 10-25mg D10W IV