EMS Assessment and Care for CVA Presented by Tom Beers EMS Coordinator for the

Stroke Facts EMS personnel play a critical role in the emergency care of acute stroke patients. Here’s why. Every 45 seconds in the United States someone experiences a stroke. Each year more than 750,000 people in the U.S. experience a stroke. Stroke is the third leading cause of death in the United States and leading cause of adult disability. Stroke is a medical emergency; Stroke is a “Brain Attack.” Stroke is treatable within 3 hours of symptom onset. EMS transport shortens time to hospital care significantly. EMS is the first medical contact for over 50 percent of stroke patients.

Introduction Stroke advancements give hope for restoration of lost neurological function key is clot-busting therapy within 3 hours of onset time lost is brain lost

Terms atherosclerosis - A condition characterized by the deposit of fatty plaques containing cholesterol and lipids on the innermost layer of the walls of large and medium-sized arteries. embolism - A clot that travels from one part of the body to another until it becomes lodged in one of the small arteries of the brain and blocks blood flow. hemorrhagic stroke - A type of stroke that occurs when a blood vessel bursts inside the brain. infarction - A localized area of cell death due to a lack of oxygenated blood. ischemia - A deficiency of oxygenated blood in a body part as a result of a constriction or blockage of the blood vessel.

Terms stroke (CVA) - A vascular disease that affects the blood vessels supplying blood to the brain. A stroke occurs when a blood vessel bringing oxygen and nutrients to the brain bursts or is clogged by a blood clot or embolus. A stroke can cause neurological deficits. thrombus - A blood clot that typically forms over fatty plaque deposits that form on the inner wall of arteries. This plaque and subsequent narrowing may progress slowly over years, particularly in those patients who smoke or have high cholesterol or high blood pressure. transient ischemic attack (TIA) - A disorder of the brain in which brain cells temporarily stop working because of insufficient oxygen causing stroke-like symptoms that resolve completely within 24 hours of onset.

Three Regions of the Brain The central nervous system is responsible for controlling voluntary and involuntary activities of the human body. Two parts of the central nervous system: brain spinal cord Three regions of the brain are: Cerebrum Cerebellum Brain Stem

Three Regions of the Brain, continued thought personality memory motor skills tactile (touch) speech vision Cerebrum

Three Regions of the Brain, continued coordination balance basic movement muscle tone 2. Cerebellum 1. Cerebrum

Three Regions of the Brain, continued heart function respiration autonomic nervous system digestion glandular secretions 2. Cerebellum 1. Cerebrum 3. Brain Stem

Types of Stroke 1 There are generally 2 types of stroke: Ischemic: A blockage caused by a clot. This is the most common type of stroke.

Types of Stroke 1 2 There are generally 2 types of stroke: Ischemic: A blockage caused by a clot. This is the most common type of stroke. 2 Hemorrhagic: A rupture caused by a break in a blood vessel. Less common than ischemic stroke but no less serious.

Types of Stroke 1 2 3 Ischemic THROMBUS clot that develops at the site of the blockage forms locally near an area of plaque causes a sudden occlusion of the blood vessel produces a sudden onset of neurological deficits 1 2 3

Types of Stroke Ischemic EMBOLUS clot floats to site to form a blockage circulates in bloodstream until it gets stuck in an artery

Types of Stroke Hemorrhagic ruptured blood vessel on the surface of the brain (subarachnoid) ruptured blood vessel within the brain (intracerebral) puts pressure against the brain

Types of Stroke BOTH TYPES OF STROKE: prevent oxygenated blood from reaching the brain tissues

Time lost is brain lost; seconds count. Types of Stroke BOTH TYPES OF STROKE: prevent oxygenated blood from reaching the brain tissues may have only minutes to get patient to definitive treatment Time lost is brain lost; seconds count.

Transient Ischemic Attack (TIA) Types of Stroke Transient Ischemic Attack (TIA) brain cells stop working because of insufficient oxygen causes stroke-like symptoms that resolve completely within 24 hours

Risk Factors Some of the factors that can contribute to stroke include: hypertension smoking age gender heredity prior stroke diabetes carotid artery disease heart disease TIAs

Signs and Symptoms Some of the signs and symptoms of stroke include: paralysis or weakness on one side of the body facial droop on one side altered level of consciousness change in personality or mood headache or dizziness impaired speech blurred vision poor coordination

Physical Exam Key clinical indicators respirations pulse mental status skin signs and color body position Relative to stroke: set of vitals to establish a baseline Cincinnati Prehospital Stroke Scale blood glucometry Look for other explanations of stroke-like symptoms (trauma, medic alert tags, drug use or diabetes). SICK or NOT SICK

Cincinnati Prehospital Stroke Scale a simplified version of the National Institutes of Health Stroke Scale accurate in identifying patients with stroke an abnormal finding in ANY of the three tests strongly suggests a stroke Test Normal Abnormal facial droop both sides of the face move equally one side of the face does not move as well as the other arm drift both arms move the same or both arms do not move at all (palms up, eyes closed) one arm drifts down compared to the other or one arm does not move speech patient says correct words with no slurring of words patient slurs words, says the wrong words, or is unable to speak

Cincinnati Prehospital Stroke Scale How does this patient appear to you? facial droop

Cincinnati Prehospital Stroke Scale How does this patient appear to you? facial droop arm drift

Cincinnati Prehospital Stroke Scale How does this patient appear to you? facial drift arm drift speech

Cincinnati Prehospital Stroke Scale How does this patient appear to you? facial droop arm drift speech

Cincinnati Prehospital Stroke Scale How about now? facial droop

Cincinnati Prehospital Stroke Scale How does this patient appear to you? facial droop arm drift

Cincinnati Prehospital Stroke Scale How does this patient appear to you? facial droop arm drift speech

Cincinnati Prehospital Stroke Scale How does this patient appear to you? facial droop arm drift speech

Chief complaint and time of onset are key in the assessment of stroke. Patient History Stroke patients often report a loss of motor function and/or a change in speech pattern. Some patients experience an altered level of consciousness. SAMPLE technique to determine if there is a history of: hypertension blood thinners or anticoagulants arteriovenous malformation (AVM) cerebral aneurysm prior stroke Chief complaint and time of onset are key in the assessment of stroke.

Clot-busting drugs must be given within 3 hours of onset of symptoms. Time of Onset determine time of onset but keep scene and transport times short be conscious of the time it takes for the hospital staff to assess and administer thrombolytic therapy Clot-busting drugs must be given within 3 hours of onset of symptoms.

Care for Stroke Care for a victim of stroke includes: protecting patient's airway ensuring adequate respirations removing secretions that can be aspirated providing ventilation assistance proper positioning administering oxygen if saturation level is below 95% or there are signs of hypoxia

Short scene and transport times are important. Short Scene Times victims of stroke often deny or rationalize their symptoms patients eligible for clot-busting drugs must be transported immediately notify the hospital that a possible stroke patient is en route avoid delays if the patient waited before calling for help Short scene and transport times are important.

Summary The three regions of the brain are the cerebrum, cerebellum and brain stem. The two basic types of stroke are ischemic (blockage) and hemorrhagic (rupture). An ischemic stroke can be caused by a thrombus which is a clot that forms in a cerebral artery or an embolus which is a clot that travels to the brain.

Summary Signs and symptoms of stroke include: paralysis or weakness on one side of the body facial droop on one side altered level of consciousness (from confusion to unconsciousness) change in personality or mood headache or dizziness impaired speech

Summary, continued The three tests of the Cincinnati Prehospital Stroke Scale are facial droop, arm drift and speech. Determine time of onset of symptoms. This helps determine if a patient meets the three-hour window for clot-busting therapy. Short scene and transport times are vital.

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