Stroke Assessment

Prepared by: Luke Winkelman NRP, EMS-I

Contributing credit: 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 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!

Stats3rd 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/

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

CVA or Stroke is a TRUE MEDICAL EMERGENCY

Risk Factors for CVA’S• Hypertenstion• Diabetes Mellitus• Arterosclerosis• African descent• Irregular heartbeat

• Hyperlipidemia• Polycythemia• Cardiac Disease• Age >55• Smoking

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*

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

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”

Cerebral Thrombus

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

Cerebral Thrombosis Con’t• Usually associtated with long HX of

vessel disease (Atherosclerosis/ Arterosclerosis)

• S/S are usually slow to develop

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.

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)

Fibrin

• Rapid Assessment and Transport is very important

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

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

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

HypertensionIrregular respirationsBradycardia

Hemorrhagic stroke treatment

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

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.

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

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: “You can’t teach an old dog new tricks”

Cincinnati Prehospital Stroke Screening• Patients with 1 of these 3 findings -as a as 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%

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• 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, 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 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.

Questions?