Stroke: Help Im Having A Brain Attack

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Stroke Help Im Having A Brain Attack

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

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Objectives

• Discuss Cerebrovascular Accidents
• Discuss risk factors for CVAS
• Discuss S/S of CVAS
• Discuss common types of CVAS
• Discuss Treatment of CVAS

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Objectives

• Discuss Cincinnati Prehospital Stroke Scale
• Discuss Los Angeles Prehospital Stroke Scale

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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!

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Also known as a STROKE
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3rd Leading cause of death in the U.S.
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CVA or Stroke is a TRUE EMERGENCY
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• Rapid Assessment and Transport is very important
• There is a 3 hour window from onset of symptoms
  to Fibrinolytic therapy

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Risk Factors for CVAS

• Hypertenstion
• Diabetes Mellitus
• Arterosclerosis

• Hyperlipidemia
• Polycythemia
• Cardiac Disease

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Signs and Symptoms of CVAS

• 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

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Most common causes of CVAS

• Cerebral Thrombosis
• Cerebral Embolus
• Cerebral Hemorrhage

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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

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Cerebral Thrombosis Cont

• Usually associtated with long HX of vessel
  disease
• S/S are usually slow to develop

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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.

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Cerebral Embolus Cont

• 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

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Cerebral Hemorrhage

• Accounts for 10 of all CVAS
• Can occur anywhere in the cranial vault
• Most common causes are Cerebral aneurysms,
  Arteriovenous Malformations, Hypertension
• 50-80 death rate

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Cerebral Hemorrhage Cont

• Commonly occurs during stress or exertion
• Presentation is often abrupt
• Pt will show signs of cushings reflex

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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

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Assessment of CVA Patient

• Universal Precautions
• Scene Safety
• Number of Patients
• Initial Impression of patient
• ABCS

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Assessment of CVA Patient Cont

• 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.

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Assessment of CVA patient Cont

• 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

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CVA is a TRUE EMERGENCY!
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Cincinnati Prehospital Stroke Screening

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

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Check for arm drift by having patient close eyes
and hold arms out for 10 seconds
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Have the Patient say a phrase to see if there is
any abnormal speech pattern. Such as The Sky
is Blue in Cincinnati
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Cincinnati Prehospital Stroke Screening

• Patients with 1 of these 3 findings -as 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

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• Another Prehospital Stroke Screening tool is the
  Los Angeles Prehospital Stroke Screening that is
  a check list of yes or no

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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

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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

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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.

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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.

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• Questions?
• Comments
• Concerns
• Snide remarks