Date of Issue: 07/01/2019 - Indian Mills Vol. Fire Co.



SUBJECT:CVA/StrokePURPOSE:To clearly establish the Department’s position on the clinical care and treatment of patients suffering from a Stroke.SCOPE: This Operating Guideline shall be applicable to all personnel; paid and volunteer, operating as an agent of Shamong EMSRESPONSIBILITY:All Department Officers will ensure overall compliance with this operating guideline. The primary responsibility of the emergency care and treatment of medical and trauma patients falls under Emergency Medical Technicians, paid and volunteer, operating as an agent of Shamong EMSPROCEDURE: Assessment Perform complete primary and secondary assessment, including obtaining a complete set of manual vital signs. ?Assess level of consciousness.Determine if alert or if responsive to?verbal or painful stimuli if LOC is depressed. Perform Cincinnati Stroke Scale evaluating the following:Facial Droop (have patient show teeth or smile)Normal – Both sides of face move equally.Abnormal – one side of face does not move as well as the other side.Arm Drift (have patient close their eyes and extend both arms straight out with palms up, for 10 seconds)Normal – Both arms move the same or both arms do not move at all.Abnormal – One arm does not move or one arm drifts down compared with the other.Abnormal Speech (have the patient say “you can’t teach an old dog new tricks”)Normal – patient uses correct words with no slurringAbnormal – patient slurs words, uses the wrong words, or is unable to speak.Interpretation: If any 1 of these 3 signs is abnormal, the probability of a stroke is 72%.Determine previous medical history, especially for history of prior?episodes, prior CVA or TIA, GI bleed, recent surgeries, recent trauma, etc. Stroke Alert GuidelinesOnset of Symptoms ≤ 8 hours for patients who present with a Cincinnati Positive Stroke Scale.If ALS is unavailable, contact Medcom (856 – 284 6644) via phone or Central Communications via radio and request they advise the receiving facility of your ETA with a Stroke Alert.“Wake up” StrokeA “wake up” stroke is considered any patient who was asymptomatic prior to going to bed (be sure to obtain approx. time patient went to bed) and woke up with stroke like symptoms.A “wake up” stroke is still a stroke alert, regardless of how long the patient was asleep for due to the fact that the time of onset is unknown and could still be within the 8 hour window.TreatmentProvide and maintain appropriate airway management.Administer and maintain appropriate dose of oxygen based on patient’s condition.?If weakness or paralysis is present, ensure the affected side is protected from injury.Transport patient to closet appropriate Stroke Center.Documentation Documentation should includeDoes the patient have a history of CVA’s or TIA’sIf so, was there any deficit or residual from the previous CVA?Time of onset of symptomsIf symptoms were noticed when the patient woke up note any complaints or symptoms prior to going to bed.Document any progression or improvement in symptoms since onset?Be sure to ask, and document any current or recent blood thinners. (Common blood thinners include: Aspirin, Coumadin, Warfarin, Heparin, Lovenox, Plavix, Pradaxa.)Include in your documentation all symptoms reported by the family followed by all symptoms you observed upon arrival.Include in your findings the conclusion of Cincinnati Stroke Scale. (If the patient meets 1/3 criteria there is a 72% chance of CVA. If the patient meets 2 or more criteria there is an 86% chance of CVA.)Also include any dysphasia, dysphagia, pupil size and reactivity.Pertinent Negatives:Recent trauma or illness?Recent complaints of headache, dizziness, weakness, dis-coordination or difficulty balancing/walking.EnforcementFailed compliance with the policy and procedures outlined in this document may result in the employee’s entry to the department’s progressive counseling and discipline process. ................
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