Stroke Administrative Guideline Flashcards
History
- Pertinent Medical history
- Hypertension
- Stroke
- Diabetes
- Medication history
- Blood thinners (and time last taken)
- Blood pressure meds
- Last known well time
Signs and symptoms
- Weakness
- Facial
- extremity
- Difficulty with speech
- Slurred
- Inappropriate verbiage
- Altered mental status
Differential
- ETOH/Drug usage
- Hypoglycemia
- Head injury
Prehospital Stroke Screen positive
AND last know well within the past 24hrs
AND symptoms onset is >4hrs
Assess for unilateral motor weakness for 10 seconds. If weakness is present, perform VAN screening. If VAN positive, transport patient to nearest Comprehensive Stroke Center
Prehospital Stroke Screen positive
AND last know well within the past 24hrs
AND symptoms onset is <4hrs
Transport to nearest Stroke Center (Primary or Comprehensive)
If transport >30 minutes, transport to closest facility
Prehospital Stroke Screen positive
AND last know well within the past 24hrs
AND symptoms onset is >4hrs
BUT there is negative VAN
You can go to either a primary or a comprehensive stroke center
Comprehensive stroke centers
BUMC Main
TMC
Primary Stroke Centers
BUMC NWMC OVH SJH SMH TMC
What do you need on all stroke patients?
FSBG,
Document last known well time
Document patient weight
18-20 g IV access x 2 (if only one, not in affected arm!), cardiac monitor
Before you leave scene, what should you probably tell the ER?
Notify Receiving Facility of Stroke Alert and relay last known well time
Notify of possible Large Vessel Occlusion
Arm drift test
Patient cloese eyes and extends both arms straight out with palms up for 10sec.
- Normal is both arms move the same or both arms do not move at all (look for pronator drift if that happens)
- Abnormal is one arm does not move or drifts downward
Facial droop test
Patient shows teeth or smile
- Normal is both sides of face move equally.
- Abnormal is one side of the face does not move as well as the other side
Abnormal speech
The patient repeats “You can’t teach an old dog new tricks”
- Normal is using the correct words with no slurring
- Abnormal is slurring words, using the wrong words, or using no words
If any of the 3 initial tests are abnormal, the probability of a stroke is __%?
72%
VAN vision
Provider holds 2 fingers to the right and one to the left while the patnet stares at the providers nose/mouth
(left and right visual fields)
Can patient correctly identify the number of fingers on both sides? Yes No
Ask the patient to look left and right one or more times. (Double vision, equal eye movements)
Do both eyes move at the same speed and direction ?
Yes No
VAN aphasia
Show the patient 2 common objects (pen, shirt) and ask patient to verbally identify.
Can patient verbally correctly identify both objects? Yes No
VAN neglect
Ask the patient to follow your finger with only their eyes form left to right. (forced gaze, inability to track)
Can patient track your finger?
Yes No
Ask the patient to close their eyes with arms by their side. Begin brushing patient’s forearms
simultaneously and ask “which arm am I touching?” (equal arm sensation)
Can patient feel both arms at the same time? Yes No
Observe if the gaze turns to one side or does not react to stimuli on one side. (does not seem to fase someone, or does not seem to hear from one side)
Can patient look, move, and react to stimuli on both sides? Yes No
If ‘no’ to any VAN criteria:
Notify receiving facility of “stroke alert” with positive VAN
