• Like
Upcoming SlideShare
Loading in...5

Thanks for flagging this SlideShare!

Oops! An error has occurred.



  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
No Downloads


Total Views
On SlideShare
From Embeds
Number of Embeds



Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

    No notes for slide


  • 1. Stroke: Help I’m Having A Brain Attack
    • Prepared By: Bill Milan NREMT-P, CCEMT-P
  • 2. Objectives
    • Discuss Cerebrovascular Accidents
    • Discuss risk factors for CVA’S
    • Discuss S/S of CVA’S
    • Discuss common types of CVA’S
    • Discuss Treatment of CVA’S
  • 3. Objectives
    • Discuss Cincinnati Prehospital Stroke Scale
    • Discuss Los Angeles Prehospital Stroke Scale
  • 4. Cerebrovascular Accident (CVA)
    • Is a sudden interruption of blood flow to the brain that results in neurological deficit
    • Similar to a heart attack time is BRAIN!
  • 5. Also known as a STROKE
  • 6. 3 rd Leading cause of death in the U.S.
  • 7. CVA or Stroke is a TRUE EMERGENCY
  • 8.
    • Rapid Assessment and Transport is very important
    • There is a 3 hour window from onset of symptoms to Fibrinolytic therapy
  • 9. Risk Factors for CVA’S
    • Hypertenstion
    • Diabetes Mellitus
    • Arterosclerosis
    • Hyperlipidemia
    • Polycythemia
    • Cardiac Disease
  • 10. Signs and Symptoms of CVA’S
    • Weakness
    • Altered LOC
    • Dizziness or Vertigo
    • Visual Disturbances
    • Facial Numbness
    • Headache
    • Convulsions
    • Incontinence
    • Dysarthria (Slurred speech
    • Aphasia (Loss of speech)
    • Hemiparesis or Hemiplegia on opposite side of affected area of the brain
  • 11. Most common causes of CVA’S
    • Cerebral Thrombosis
    • Cerebral Embolus
    • Cerebral Hemorrhage
  • 12. Cerebral Thrombosis
    • Most common type of CVA
    • Commonly occurs at night with pt. Awakening with ALOC, or loss of speech, sensory, or motor function
    • Headache is not common with this type of CVA
  • 13. Cerebral Thrombosis Con’t
    • Usually associtated with long HX of vessel disease
    • S/S are usually slow to develop
  • 14. Cerebral Embolus
    • Embolus generally orginates in neck or heart and travels till it reaches the brain.
    • Most common types of Embolus are: Clotted blood, Air bubbles, tumor fragments, or fat particles.
  • 15. Cerebral Embolus Con’t
    • Symptoms usually occur when pt. Is awake and active.
    • S/S usually more rapid to develop and have identifiable causes( I.E. A-Fib, Valvular Heart disease)
    • Headache is common with the type of CVA
  • 16. Cerebral Hemorrhage
    • Accounts for 10% of all CVA’S
    • Can occur anywhere in the cranial vault
    • Most common causes are: Cerebral aneurysms, Arteriovenous Malformations, Hypertension
    • 50-80% death rate
  • 17. Cerebral Hemorrhage Con’t
    • Commonly occurs during stress or exertion
    • Presentation is often abrupt
    • Pt will show signs of cushing’s reflex
  • 18. Transient Ischemic Attack (TIA)
    • Referred to as little or mini Strokes
    • Symptoms usually last 24-72 hours then resolve
    • Precursor to a CVA within 2 yrs of onset of TIA
  • 19.  
  • 20. Assessment of CVA Patient
    • Universal Precautions
    • Scene Safety
    • Number of Patients
    • Initial Impression of patient
    • ABC’S
  • 21. Assessment of CVA Patient Con’t
    • Oxygen therapy and ventilatory support if needed including Intubation.
    • Prehospital Screening (Cincinnati Prehospital Screening Scale, Los Angeles Prehospital Screening Scale)
    • Obtain IV of NS or LR or Saline Lock and obtain blood samples.
  • 22. Assessment of CVA patient Con’t
    • Check blood sugar and treat if indicated
    • Thiamine 100mg if malnourished,or alcoholic
    • Cardiac monitor including 12 lead ECG
    • Elevate head 15 degrees to facilitate venous drainage if not contraindicated.
    • Rapid transport
    • Notify ER as soon as possible
  • 23. CVA is a TRUE EMERGENCY!
  • 24. Cincinnati Prehospital Stroke Screening
    • Check for facial drooping have patient smile or show teeth.
  • 25.  
  • 26. Check for arm drift by having patient close eyes and hold arms out for 10 seconds
  • 27.  
  • 28.  
  • 29. Have the Patient say a phrase to see if there is any abnormal speech pattern. Such as: The Sky is Blue in Cincinnati
  • 30. Cincinnati Prehospital Stroke Screening
    • Patients with 1 of these 3 findings - as a new event - have a 72% probability of an ischemic stroke.
    • If all 3 findings are present the probability of an acute stroke is more than 85%
  • 31. Another Prehospital Stroke Screening tool is the Los Angeles Prehospital Stroke Screening that is a check list of yes or no
  • 32. Los Angeles Prehospital Stroke Screening
    • Age Greater than 45
    • Hx of seizures or epilepsy
    • Symptoms duration less than 24 hours
    • Pt. Not wheelchair or bed ridden
    • Blood glucose between 60-400
    • Facial droop, grip alterations, or loss of arm strength
  • 33. Los Angeles Prehospital Stroke Screening
    • 93% of stroke patients will have a positive LAPSS
    • 97% of the patients with a positive LAPSS will have a stroke
  • 34. Stroke
    • Once a stroke is identified in the field time should be minimized on scene.
    • Most interventions should be performed enroute to ED.
    • Time is the most important aspect of the exam due to potential therapy.
    • Careful assessment is essential due to S/S may be very subtle.
  • 35. Summary
    • Early detection and transport of CVA/TIA will have a dramatic effect of the mortality and morbidity of patients. Using the Cincinnati Stroke Scale or Los Angeles Stroke Scale an EMT or Paramedic can quickly and accurately access the neurological status of a patient presenting with CVA/TIA Signs and symptoms and should transport rapidly to decrease time to treatment.
  • 36.
    • Questions?
    • Comments
    • Concerns
    • Snide remarks