Stroke is the third leading cause of death and the leading cause of disability in the US. It occurs when blood flow to the brain is disrupted, either from a blockage (ischemic stroke) or bleeding (hemorrhagic stroke). Common symptoms include sudden weakness or numbness on one side of the body, difficulty speaking or understanding speech, and vision problems. It is important for EMS to recognize stroke symptoms and assess using tools like the Cincinnati or LAPSS scales, and to rapidly transport potential stroke patients to the hospital so they can receive treatments like tPA that are most effective within 4.5 hours of symptom onset.

1. Chapter 16
Stroke

2. QUESTION:
 WHAT IS THE LEADING CAUSE OF DEATH
IN THE USA?

3. Stroke is the 3rd leading cause of
death in the USA
800,000/ year

4. QUESTION:
 WHAT IS THE LEADING CAUSE OF
DISABILITY IN THE USA?

5. Stroke is the leading cause of
disability in the USA.

6.  An alteration in mental status is a finding
caused by some other condition that
affects how the brain functions
 Strokes are one of those conditions that
can cause a loss of speech, sensory, or
motor function
Introduction

7.  A neurologic deficit is one that causes a
change in the patient’s ability to speak,
feel, or move
 This could be a medical or traumatic
cause, but this discussion will be limited
to the presentation of a non-traumatic
brain injury, or stroke
Neurologic Deficit
Resulting from Stroke

8.  Strokes are the third leading cause of
death in the U.S.
 EMS plays a large role as early
recognition and treatment is key to
reducing the mortality rates from
strokes
Acute Stroke
http://www.stroke.org/

9.  Overview of the disease process
– Two general types of strokes exist:
 Ischemic
 Hemorrhagic
– Regardless of the type of stroke, both
result in inadequate perfusion to a region
of the brain.
Acute Stroke

10.  Ischemic strokes
– Thrombus
Enrichment

11.  Ischemic strokes
– Embolism
Enrichment

12.  Hemorrhagic strokes
– Rupture of a blood vessel
Enrichment

13. SAVE THE PENUMBRA

20. – Because of the disruption in perfusion, the
symptoms that develop are a function of
the region of the brain involved
– Most commonly, strokes affect the regions
of the brain that control speech,
sensation, and muscle function
Acute Stroke

21. Acute Stroke
The stroke patient
will often suffer
paralysis affecting
the face and
extremities on one
side of the body

22.  Assessment: focused history and physical
– Responsive patient (low priority)
– Unresponsive patient (high priority)
Acute Stroke

23.  Assessment: SAMPLE history
– Along with the normal SAMPLE questions,
consider asking questions specifically
geared towards determining stroke status
Acute Stroke

24.  Assessment: SAMPLE history
– Also ask the questions that will help
answer things the hospital needs to know
in order to administer certain clot
dissolving medications
Acute Stroke

25.  Stroke symptoms usually come on suddenly, and
should always be treated as a medical emergency.
They include a sudden onset of any of the
following:
•Weakness of the face, arm, and/or leg on one
side of body
•Numbness in the face, arm, and/or leg one side
of body
•Inability to understand spoken language
•Inability to speak
•Inability to write
•Vertigo and/or gait imbalance
•Double vision
(The Stroke Network, 2011)

26.  Assessment: physical exam
 Cincinnati Prehospital Stroke Scale
– Takes into consideration facial droop, arm drift, and
abnormal speech patterns
 Los Angeles Prehospital Stroke Screen (LAPSS)
– Considers the above three physical findings as well
as additional findings which could identify a stroke
Acute Stroke

28. TIME TO ACT FAST
 F- FACE
 A-ARM
 S-SPEECH
 T-TIME

29.  USE F.A.S.T. BELOW TO DETERMINE IF YOU ARE HAVING A
STROKE
F- Face - Ask the person to smile. If one side of the face
appears to be crooked or drooping Call 911
A - Arms - Ask the person to raise both arms in the air. If
there is difficulty with one arm Call 911
S - Speech - Ask the person to speak. If the words are
slurred or he/she can not speak Call 911
T- Time - Time is of the essence. Call 911 If any of the
above symptoms exist, Do Not take aspirin and Do not call
us!
tPA is a treatment for Stroke that must be performed within
4.5 hours of the onset of stroke symptoms.
(F.A.S.T. , 2010 National Stroke Association)

30.  Assessment: physical exam
– Three most common findings are:
 Facial drooping
 Abnormal arm drift
 Speech disturbance
Acute Stroke

31.  Assessment: physical exam
– Evidence of facial droop
Acute Stroke

32.  Assessment: physical exam
– Evidence of arm drift
Acute Stroke

33. Acute Stroke
Cincinnati Prehospital Stroke Scale

34. Acute Stroke
Los Angeles Prehospital Stroke Scale (LAPSS)

35. Acute Stroke
General
signs and
symptoms
of a stroke

36.  Emergency medical care
– Maintain a patent airway
– Provide high flow oxygen
– Assure breathing adequacy
– Position the patient
– Obtain BGL if warranted
– Position the patient and protect paralyzed
extremities
Acute Stroke

37.  Emergency medical care
– Patient positioning unresponsive
Acute Stroke

38.  Emergency medical care
– Patient positioning responsive
Acute Stroke

40. TIME IS BRAIN
 EVERY MINUTE VICTIM LOSE:
– 2 million neurons
– 14 billion synapses
– 7.5 miles of myelinated fibers

41. WHAT TO DO?
 Get me a good history,please!!!
 Keep the HOB flat
 Call the ER with a stroke code
 Tell the family to go to ER stat/bring an
eyewitness with you/get a phone number

42. “GOLDEN HOUR”
 15 minutes for CT Brain
 15 minutes for ER Doc to
see patient
 30 minutes CT read and
Pt inc/exclusion
 40 minutes for lab
 60 minutes for bolus
 Dose:
– 0.9 mg/kg, max 90mg
– 10% bolus in 1 minute
– 90% over one hour

43. TPA WORKS
 Door to needle in less than 60 minutes

46.  Transient Ischemic Attack (TIA)
– A TIA looks just like a CVA symptomatically
– TIA disappears within 24 hours of onset,
without any permanent neurological
changes
– Usually, symptoms subside within 15–30
minutes
Acute Stroke

50. Thank You!