Stroke Administrative Guideline

Question 1

History

Answer 1

• Pertinent Medical history
• Hypertension
• Stroke
• Diabetes
• Medication history
• Blood thinners (and time last taken)
• Blood pressure meds
• Last known well time

Question 2

Signs and symptoms

Answer 2

• Weakness
• Facial
• extremity
• Difficulty with speech
• Slurred
• Inappropriate verbiage
• Altered mental status

Question 3

Differential

Answer 3

• ETOH/Drug usage
• Hypoglycemia
• Head injury

Question 4

Prehospital Stroke Screen positive
AND last know well within the past 24hrs
AND symptoms onset is >4hrs

Answer 4

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

Question 5

Prehospital Stroke Screen positive
AND last know well within the past 24hrs
AND symptoms onset is <4hrs

Answer 5

Transport to nearest Stroke Center (Primary or Comprehensive)
If transport >30 minutes, transport to closest facility

Question 6

Prehospital Stroke Screen positive
AND last know well within the past 24hrs
AND symptoms onset is >4hrs
BUT there is negative VAN

Answer 6

You can go to either a primary or a comprehensive stroke center

Question 7

Comprehensive stroke centers

Answer 7

BUMC Main

TMC

Question 8

Primary Stroke Centers

Answer 8

BUMC
NWMC
OVH
SJH
SMH
TMC

Question 9

What do you need on all stroke patients?

Answer 9

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

Question 10

Before you leave scene, what should you probably tell the ER?

Answer 10

Notify Receiving Facility of Stroke Alert and relay last known well time
Notify of possible Large Vessel Occlusion

Question 11

Arm drift test

Answer 11

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

Question 12

Facial droop test

Answer 12

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

Question 13

Abnormal speech

Answer 13

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

Question 14

If any of the 3 initial tests are abnormal, the probability of a stroke is __%?

Answer 14

72%

Question 15

VAN vision

Answer 15

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

Question 16

VAN aphasia

Answer 16

Show the patient 2 common objects (pen, shirt) and ask patient to verbally identify.
Can patient verbally correctly identify both objects? Yes No

Question 17

VAN neglect

Answer 17

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

Question 18

If ‘no’ to any VAN criteria:

Answer 18

Notify receiving facility of “stroke alert” with positive VAN