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Assessing & Managing Stroke Patients
Time: 1 hour
References: Brady Emergency Care, 13thed (pp. 549-552) & Maryland Protocols (pp. 14-15, 152-155)
Student Objective: Given information & resources, BLS providers will be able to identify signs of a stroke, emergency care, and stroke centers.
Overview:
• Signs of a stroke
• Emergency Care
• Stroke Centers
Signs of a stroke(pp. 548-551)
• One sided weakness
• Headache
• Difficulty speaking or complete inability to speak
• Confusion
• Dizziness
• Impaired vision
• Hypertension
• Nausea or vomiting
• Loss of bowel/bladder control
• Seizure
• Unequal pupils
• Loss if vision in one eye
• Unconsciousness (uncommon)
• Difficulty breathing or snoring respirations
Assessment (pp. 549-551)
Cincinnati Prehospital Stroke Scale(MMP pp. 153)
Note: if a patient demonstrates any of the following, there is a 70% chance that the patient is having an acute stroke
1) Assess facial droop – abnormal facial droop on one side
2) Assess speech difficulties –often has slurred speech, use wrong words, or unable to speak at all
3) Arm drift – often has arm drift or palm rotation
Emergency Care Procedures
• Brady Emergency Care, 13thed (pp. 552)
o Establish & maintain a patent airway
o Provide supplemental oxygen if O2 saturation is under 94%
o Perform blood glucose analysis
o Attempt to determine the exact onset of the stroke
o Transport to a facility that can manage a patient with symptoms of a stroke
• Maryland Medical Protocols, July 1, 2017 (pp.152-155)
o Support the ABC’s
o Perform the Cincinnati Prehospital Stroke Scale
o If Cincinnati Stroke Scale is positive, perform the Los Angles Motor Scale (LAMS) (pp. 153)
o Position patients head at 30 degrees
o Complete the Fibrinolytic Checklist for Ischemic Stroke (pp. 155)
o If the patient is a candidate for fibrinolytic therapy AND can be delivered to the hospital within 3.5 hours of the last known well time, transport the patient to a stroke center. If there is no stroke center within 30 minutes, then go to the closest hospital
o If the patient meets the criteria, the patient is a Priority 1 and requires notification of the nearest designated stroke center. Use the verbiage “Stroke Alert”.
o Place pediatric patients on oxygen 2-6lpm nasal cannula unless hypoxic or in respiratory distress
o Primary Stroke Centers (pp. 14-15)
▪ Anne Arundel Medical Center, Annapolis
▪ Atlantic General Hospital, Berlin
▪ Baltimore Washington Medical Center (UM), Glen Burnie
▪ Calvert Memorial Hospital, Prince Frederick
▪ Carroll Hospital Center, Westminster
▪ Charles Regional Medical Center (UM), La Plata
▪ Franklin Square Medical Center (MedStar), Baltimore
▪ Frederick Memorial Hospital, Frederick
▪ Good Samaritan Hospital (MedStar), Baltimore
▪ Greater Baltimore Medical Center, Baltimore
▪ Harbor Hospital (MedStar), Baltimore
▪ Harford Memorial Hospital (UMUCH), Havre De Grace
▪ Holy Cross Hospital, Silver Spring
▪ Howard County General Hospital (JHA), Columbia
▪ Johns Hopkins Bayview Medical Center, Baltimore
▪ Mercy Medical Center, Baltimore
▪ Meritus Medical Center, Hagerstown
▪ Midtown Campus (UM), Baltimore
▪ Montgomery Medical Center (MedStar), Olney
▪ Northwest Hospital, Baltimore
▪ Peninsula Regional Medical Center, Salisbury
▪ Saint Agnes Hospital, Baltimore
▪ Saint Joseph Medical Center (UM), Baltimore
▪ Saint Mary’s Hospital (MedStar), Leonardtown
▪ Shady Grove Adventist Hospital, Rockville
▪ Shore Medical Center at Easton (UMSRH)
▪ Sinai Hospital of Baltimore
▪ Southern Maryland Hospital (MedStar), Clinton
▪ Suburban Hospital (JHM), Bethesda
▪ Union Hospital of Cecil County, Elkton
▪ Union Memorial Hospital (MedStar), Baltimore
▪ Upper Chesapeake Medical Center (UMUCH), Bel Air
▪ Washington Adventist Hospital, Takoma Park
▪ Western Maryland Regional Medical Center, Cumberland
o Comprehensive Stroke Centers (pp. 15)
▪ The Johns Hopkins Hospital, Baltimore
▪ University of Maryland Medical Center, Baltimore
Review:
• Signs of a stroke
• Emergency Care
• Stroke Centers
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