Uploaded byRommie Duckworth
Stroke in the Young
The document discusses stroke in young people and children. It notes that stroke is a leading cause of death and disability, even occurring in newborns. EMS plays a vital role in properly assessing and managing stroke patients, especially the young, to improve outcomes. Recognizing stroke symptoms and risk factors, without assuming stroke mimics, can help identify stroke early in complex cases. Using validated scales and coordinating with hospitals can also help manage young stroke patients.
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Stroke in the Young
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- 7. 1) Improved Understanding Assessment & management by EMS plays a vital role in patient outcome. 2) Improved Awareness Knowing stroke risk factors in a younger patient’s history will help alert you to the possibility of stroke, even in complex and difficult cases. 3) Improved Assessment Be especially suspicious of new onset, focal neurological deficits. Don’t assume a stroke mimic just because of the patient’s age. 4) Improved Care Know and use both general management & specific stroke care recommendations for patients <45 years old, <18 years old, and newborns. 5) Improved Coordination Know and use a validated stroke scale improving identification of stroke and assisting in coordination with hospital staff. http://www.flickr.com/photos/49656291@N00/3573339704/
- 11. Stroke in NorthAmerica & Europe… 4th Leading Cause of Death. Leading Cause of Disability.
- 12. Stroke in-utero & newborns >1in 4,000 births Primarily in full-term infants
- 13. Stroke in theVery Young 6th Leading Cause of Death 1 in 10,000
- 14. September 2013 Articlein Neurology estimates 500,00 – 850,000 Americans 18 – 14 y/o have had a stroke
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- 25. http://www.flickr.com/photos/denverjeffrey/3131407707/ “I believe thatEMS is the key to improving treatment of childhood stroke in the acute setting. I have seen multiple cases where EMS takes a child into a pediatric ER and they are thinking stroke before the pediatrician. This is simply because EMS sees stroke every day and pediatricians do not.”
- 26. http://www.flickr.com/photos/denverjeffrey/3131407707/ “The average timeto stroke diagnosis is 24 hours. In order to offer acute therapies, such as tPA (a clot buster) to children, we are going to have to reduce that time greatly. In my opinion, EMS is the most important part of this effort.”
- 27. It is importantto keep an open mind to the possibility of stroke in the young, and not presume that complaints are due to stroke mimics. “All patients exhibiting potential stroke symptoms should be treated as if they were having a stroke, until proven otherwise.” http://www.flickr.com/photos/cmspooner/1177006593/
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- 39. Young victims ofstroke tend to have better outcomes than older patients with similar injuries.
- 40. The TIPS trial (Thrombolysisin Pediatric Stroke)
- 41. Stroke Systems ofCare have been shown to provide the best patient outcome for stroke victims of all ages.
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- 43. 1) Improved Understanding Assessment & management by EMS plays a vital role in patient outcome. 2) Improved Awareness Knowing stroke risk factors in a younger patient’s history will help alert you to the possibility of stroke, even in complex and difficult cases. 3) Improved Assessment Be especially suspicious of new onset, focal neurological deficits. Don’t assume a stroke mimic just because of the patient’s age. 4) Improved Care Know and use both general management & specific stroke care recommendations for patients <45 years old, <18 years old, and newborns. 5) Improved Coordination Know and use a validated stroke scale improving identification of stroke and assisting in coordination with hospital staff. http://www.flickr.com/photos/49656291@N00/3573339704/
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Editor's Notes
- #3 December, 2012 at the age of 26, Frankie Muniz, “ Malcom ” in the Middle, suffered a stroke.
- #4 While the assessment and treatment of stroke in young patients (under 45 years old), very young patients (under 18 years old) and newborns presents unique challenges to EMS providers, these challenges can be overcome by a knowledge and awareness of this highly under-recognized emergency.
- #5 While the assessment and treatment of stroke in young patients (under 45 years old), very young patients (under 18 years old) and newborns presents unique challenges to EMS providers, these challenges can be overcome by a knowledge and awareness of this highly under-recognized emergency.
- #6 Assess & Tx of stroke in young patients presents unique challenges to EMS providers
- #7 these challenges can be overcome by a knowledge and awareness of this highly under-recognized emergency.
- #8 Dr. Bernard says “Speak up to the physicians if you think one of your patients has had a stroke.”
- #12 Disease of the elderly BUT CDC reports alarming increase in incidence among the young. While >65 years of age remain at the highest risk great strides in prevention & care being made. In recent years stroke has fallen from the third to the fourth leading cause of death in the United States 4 . Yet at the same time, according to a recent study from the CDC, incidence stroke is growing among the young and the very young, and the rate of stroke in newborns continues at an alarming rate.
- #13 Incidence stroke is growing among the young and the very young, and the rate of stroke in newborns continues at an alarming rate.
- #14 Incidence stroke is growing among the young and the very young, and the rate of stroke in newborns continues at an alarming rate.
- #15 Incidence stroke is growing among the young and the very young, and the rate of stroke in newborns continues at an alarming rate.
- #16 Known contributing risk factors of stroke in the young can be identified through a thorough patient history. Pre-hospital care providers will need to raise their index of suspicion as a vague presentation of neurological symptoms in a young person may, in fact, be signs of a stroke.
- #17 Known contributing risk factors of stroke in the young can be identified through a thorough patient history. Pre-hospital care providers will need to raise their index of suspicion as a vague presentation of neurological symptoms in a young person may, in fact, be signs of a stroke.
- #18 Known contributing risk factors of stroke in the young can be identified through a thorough patient history. Pre-hospital care providers will need to raise their index of suspicion as a vague presentation of neurological symptoms in a young person may, in fact, be signs of a stroke.
- #19 Known contributing risk factors of stroke in the young can be identified through a thorough patient history. Pre-hospital care providers will need to raise their index of suspicion as a vague presentation of neurological symptoms in a young person may, in fact, be signs of a stroke.
- #20 By their very nature, newborn patients can be difficult to assess. In addition, many of the definitive signs and symptoms of stroke in the newborn may not present for several months. Still, a keenly observant prehospital care provider may be the first person to identify the issues that will lead to comprehensive care, assessment and follow-up for newborn victims of stroke.
- #21 Known contributing risk factors of stroke in the young can be identified through a thorough patient history. Pre-hospital care providers will need to raise their index of suspicion as a vague presentation of neurological symptoms in a young person may, in fact, be signs of a stroke.
- #23 In Detroit, doctors encountered a 40-year-old patient who had no trouble reading, writing or understanding language. His only consistent problem was that he had lost the ability to type coherent text messages on his phone. In December, a report in The Archives of Neurology described a 25-year-old pregnant woman whose husband grew concerned after she sent him a series of incoherent text messages. a lesion in a part of the brain that involves language production, called Broca’s area.
- #29 Many EMS providers may be inclined to assume that a strokes in young patients that was missed in the field will naturally get picked up in the emergency department.
- #30 Many EMS providers may be inclined to assume that a strokes in young patients that was missed in the field will naturally get picked up in the emergency department.
- #31 Accomplishing this in the most efficient way will give your patient the best chance for a positive outcome.
- #36 contributing or comorbid diseases
- #39 D50%, D25%, D10% appears to be even better as it is easier to mix without error and the dilute concentration has fewer side effects.
- #40 While there is no definitive answer as to why this is the case, theories include the fact that young patients tend to have fewer co-morbidities and better “neuroplasticity” (adaptability of the brain) and potential for regeneration than older patients. That being said, a stroke in a young person is still a critical incident, especially for very young patients. According to Dr. Bernard 70%-80% of these patients will have a lifelong disability associated with their stroke. 14 In addition, they can often have a worse acute period of stroke as they have less collateral circulation and less room in the cranium to accommodate the cerebral edema that often accompanies stroke says Dr. McCullough.
- #41 Dr. Bernard says, “This is the first treatment trial in childhood stroke, and it is look at the safety of tPA ( a clot buster) in the acute setting of stroke in children age 2-18 years.”, emphasizing, “Since this is a time-limited trial (kids need to be enrolled within 4.5 hour of their stroke), EMS will be crucial to our success.”
- #42 Dr. Bernard says, “This is the first treatment trial in childhood stroke, and it is look at the safety of tPA ( a clot buster) in the acute setting of stroke in children age 2-18 years.”, emphasizing, “Since this is a time-limited trial (kids need to be enrolled within 4.5 hour of their stroke), EMS will be crucial to our success.”
- #44 Dr. Bernard says “Speak up to the physicians if you think one of your patients has had a stroke.”
- #45 Remember, EMS is responsible for the first five of the eight “ D ’ s of stroke care ” .
- #46 Remember, EMS is responsible for the first five of the eight “ D ’ s of stroke care ” .