Stroke is a leading cause of death and disability in the United States. Strokes occur when blood flow to the brain is interrupted by a clot or ruptured blood vessel. Common signs and symptoms include weakness on one side of the body, difficulty speaking, and headaches. The Cincinnati Stroke Scale can reliably identify strokes, requiring just one positive finding from tests of facial asymmetry, arm strength, and speech. Paramedics should follow stroke alert protocols, administering oxygen and starting IVs while transporting patients to the hospital within 60 minutes to receive treatments like t-PA that can reduce disability from strokes.

1. Stroke Recognition and Treatment Don Stroup, CC/NREMT-P Poudre Valley Ambulance Service This review is intended to compliment the Stroke Alert training you recently received. If you have any questions or comments, please refer to the Stroke Alert Presentation and protocol, or contact Don Stroup. Thank you.

2. First, the Impact Stroke is the third leading cause of death in the United States. Over 160,000 people die each year from stroke. Stroke is the leading cause of serious long-term diability. ¾ of all strokes occur in people over the age of 65. The risk of having a stroke more then doubles each decade after 55. Strokes cost almost $57 billion in direct and indirect costs each year. Source: CDC 2008

3. Pathophysiology Strokes are caused by an interruption of blood flow to the brain. This can be the result of a clot or a rupture in a blood vessel. The interruption of blood flow will cause a variety of neurological signs and symptoms that must be rapidly recognized and treated.

4. Signs and Symptoms of Stroke Rapid onset and frequently more then one sign or symptom. Most common Hemiparesis Difficulty speaking Headache, sometimes severe Difficulty seeing in one or both eyes. Balance and coordination issues

5. Recognizing Stroke in the Field Cincinnati Stroke Scale High degree of reliability identifying stroke Three step process Assess facial asymmetry Arm drift Difficulty speaking Pt. is unable to repeat a phrase or has difficulty forming words Over 70% accurate when one sign is present Over 80% accurate when two or more signs are present Only need one positive finding to qualify for a stroke alert!!!!

6. Treatment and Transport IV 18g x2 At least one in the AC Maintain SpO2 at 92% Provide O2 only if needed Follow Stroke Alert protocol Provide NOTHING by mouth! If pt. is hypoglycemic, provide IV dextrose or Glucagon Probably not a stroke either!

7. Flashy Bits or no Flashy Bits? Transporting emergent or non-emergent is up to you; consider the patient Keep in mind the four hour time limit for the Stroke Alert.

8. Hospital Treatment and Ongoing Care Rapid CT and diagnosis of embolic stroke is the key PVH goal is less then 60 minutes, door to needle t-PA is the fibrinolytic of choice, used to break up clots and hopefully restore circulation/ neuro function If the stroke is caused by a bleed, then patient is flown to Denver for additional treatment. The patient may also be flown if they are outside the 3 hour time frame for t-PA. Post Stroke: Neuro rehab and stabilization

9. Quiz List three signs or symptoms of stroke. How many positive findings on the Cincinnati Stroke Scale are needed to call a Stroke Alert? All patients suffering a stroke should be transported emergent. True or False? If the patient is outside the three hour t-PA window, then they do not qualify for a Stroke Alert. True or False? The risk of stroke more then doubles each decade after 55. True of False?

10. RESOURCES U.S. Government (2007). Stroke Facts and Statistics. Center for Disease Control and Prevention. Retrieved February 21 2008 from http://www.cdc.gov/stroke/stroke_facts.htm