Stroke: Help I’m Having A Brain Attack

• Prepared By: Bill Milan NREMT-P, CCEMT-P

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

Objectives

• Discuss Cincinnati Prehospital Stroke Scale

• Discuss Los Angeles Prehospital Stroke Scale

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!

Also known as a STROKE

3rd Leading cause of death in the U.S.

CVA or Stroke is a TRUE EMERGENCY

• Rapid Assessment and Transport is very important

• There is a 3 hour window from onset of symptoms to Fibrinolytic therapy

Risk Factors for CVA’S

• Hypertenstion• Diabetes Mellitus• Arterosclerosis

• Hyperlipidemia• Polycythemia• Cardiac Disease

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

Most common causes of CVA’S

• Cerebral Thrombosis• Cerebral Embolus• Cerebral Hemorrhage

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

Cerebral Thrombosis Con’t

• Usually associtated with long HX of vessel disease

• S/S are usually slow to develop

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.

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

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

Cerebral Hemorrhage Con’t

• Commonly occurs during stress or exertion

• Presentation is often abrupt• Pt will show signs of cushing’s

reflex

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

Assessment of CVA Patient

• Universal Precautions• Scene Safety• Number of Patients• Initial Impression of patient• ABC’S

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.

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

CVA is a TRUE EMERGENCY!

Cincinnati Prehospital Stroke Screening

• Check for facial drooping have patient smile or show teeth.

Check for arm drift by having patient close eyes and hold

arms out for 10 seconds

Have the Patient say a phrase to see if there is any abnormal speech pattern.

Such as: The Sky is Blue in Cincinnati

Cincinnati Prehospital Stroke Screening

• Patients with 1 of these 3 findings -as a new eventas 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%

Another Prehospital Stroke Screening tool is the Los Angeles Prehospital Stroke Screening

that is a check list of yes or no

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

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

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.

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.

• Questions?• Comments• Concerns• Snide remarks