This document discusses stroke assessment for EMS providers. It defines a stroke as a sudden interruption of blood flow to the brain, outlines risk factors like hypertension and smoking, and describes common types such as thrombosis and hemorrhage. Signs and symptoms include weakness, altered mental status, and slurred speech. It emphasizes the importance of rapid assessment using tools like the Cincinnati Prehospital Stroke Scale and urgent transport to treat strokes within 3 hours of onset. Early detection and transport by EMS can significantly impact outcomes for stroke patients.

1. Stroke Assessment
Prepared by:
Luke Winkelman
NRP, EMS-I
Contributing credit: 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 or Stroke)
• Is a sudden interruption of blood flow to
the brain that results in neurological
deficit
• Similar to a heart attack Time is BRAIN!

5. Stats
3rd
Leading cause of death in the U.S.
More than 140,000
people die each
year from stroke in
the United States.
http://www.strokecenter.org/patients/about-stroke/stroke-statistics/

6. Stats
• Strokes can and do occur at
ANY age. Nearly one fourth of
strokes occur in people under
the age of 65.
• Stroke is the leading cause of
serious, long-term disability in
the United States.
• Each year, approximately
795,000 people suffer a stroke.
U.S. Stroke Deaths, 2000–2006, by County

7. CVA or Stroke is a
TRUE MEDICAL EMERGENCY

8. Risk Factors for CVA’S
• Hypertenstion
• Diabetes Mellitus
• Arterosclerosis
• African descent
• Irregular heartbeat
• Hyperlipidemia
• Polycythemia
• Cardiac Disease
• Age >55
• Smoking

9. Signs and Symptoms of CVA’S
• Weakness
• Altered LOC
• Dizziness or Vertigo
• Visual Disturbances
• Facial Numbness
• Severe Headache
• Convulsions/Seizure
• Incontinence
• Nausea/vomiting
• Dysarthria (Slurred
speech
• Aphasia (Loss of
speech)
• Hemiparesis or
Hemiplegia on opposite
side of affected area of
the brain*

10. Most common causes of CVA’S
• Cerebral Thrombosis
• Cerebral Embolus
• Cerebral Hemorrhage

11. Transient Ischemic Attack (TIA)
• Referred to as little or mini Strokes
• Symptoms usually last 1-2 hours then
resolve (sometimes as long as 24h)
• Precursor to a CVA within 2 yrs of onset
of TIA
• A “Sign of things to come”

12. Cerebral Thrombus

13. Cerebral Thrombosis
• Clot forms at blockage site
• Most common type of CVA
• Commonly occurs at night with pt.
Awakening with Altered LOC, or loss of
speech, sensory, or motor function

14. Cerebral Thrombosis Con’t
• Usually associtated with long HX of
vessel disease (Atherosclerosis/
Arterosclerosis)
• S/S are usually slow to develop

15. Cerebral Embolus
• Clot/foreign particle travels to blockage
• Embolus generally originates 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.

16. 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)

17. Fibrin

18. • Rapid Assessment
and Transport is
very important
• There is a 3 hour
window from onset
of symptoms to
Fibrinolytic therapy

19. Cerebral Hemorrhage
• Accounts for 10% of all CVA’S
• Can occur anywhere in the
cranial vault
• Most common causes are:
Ruptured cerebral aneurysms,
Arteriovenous Malformations,
Hypertension
• 50-80% death rate

20. Cerebral Hemorrhage Con’t
• Commonly occurs during stress or exertion
• Presentation is often abrupt
• Pt will show signs of “Cushing’s Triad”
Hypertension
Irregular respirations
Bradycardia

21. Hemorrhagic stroke treatment

23. Assessment of CVA Patient
• Universal Precautions
• Scene Safety
• Initial Impression of patient
• ABC’S

24. Assessment of CVA Patient Con’t
• Oxygen therapy if <94% and ventilatory
support if needed adjunct.
• Prehospital Screening (Cincinnati
Prehospital Screening Scale, Los
Angeles Prehospital Screening Scale)
• Obtain IV of NS or LR or Saline Lock,
as few attempts as possible.

25. Assessment of CVA patient Con’t
• Check blood sugar and treat if indicated
• 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 of
incoming CVA patient

26. Cincinnati Prehospital Stroke
Screening
• Check for facial drooping have patient
smile or show teeth.

28. Check for arm drift by having
patient close eyes and hold arms
out for 10 seconds

31. Have the Patient say a phrase to see if
there is any abnormal speech pattern.
Such as:
“You can’t teach an old dog new tricks”

32. Cincinnati Prehospital Stroke
Screening
• Patients with 1 of these 3 findings -as aas a
new eventnew 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%

33. Another Prehospital Stroke Screening tool is the
Los Angeles Prehospital Stroke Screening that is a
check list of yes or no

34. 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

35. Los Angeles Prehospital Stroke
Screening
• 97% of the patients with a positive
LAPSS will have a stroke

37. 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, S/S
may be very subtle.

38. 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
EMS provider 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.

39. Questions?