ACLS review: Acute Stroke Part 2

Warning Signs and Symptoms of Possible Stoke

·         Sudden onset of weakness

·         Sudden confusion

·         Trouble speaking or understanding

·         Sudden trouble seeing in one or both eyes

·         Sudden trouble walking

·         Dizziness or loss of balance or coordination

·         Sudden severe headache with no known cause

Note:  Identifying clinical signs of possible stroke is important because recanalization strategies (intravenous [IV] fibrinolysis and intra-arterial/catheter-based approaches) must be provided within the first few hours from onset of symptoms

Public Education

·         Public must be educated regarding the signs and symptoms of a stroke

·         Public must be educated to activate EMS as soon as symptoms of stroke are recognized

·         Currently half of all stoke patients are drive to the hospital by their family members

Note:  Most strokes occur at home, and just over half of all victims of acute stroke use EMS for transport to the hospital.  Stroke knowledge among the lay public remains poor.  These factors can delay EMS access and treatment, resulting in increased morbidity and mortality.
Educational efforts need to couple the knowledge of the signs and symptoms of stroke with action—call 911

Advantages of Activating EMS for Symptoms of a Stoke

·         EMS personal can quickly assess and identify a stoke patient

·         EMS can quickly transport the stoke patient to the hospital thus minimizing the interval between the onset of symptoms and treatment.

·         Prearrival notification allows the hospital to prepare to evaluate and manage the patient efficiently

The Cincinnati Prehospital Stroke Scale

·         Facial droop

·         Arm drift

·         Abnormal speech

Note:  With standard training in stroke recognition, paramedics demonstrated a sensitivity of 61% to 66% for identifying patients with stroke. After receiving training in use of a stroke assessment tool, paramedic sensitivity for identifying patients with stroke increased to 86% to 97%

Circulation. 2010; 122: S818-S828 doi: 10.1161/​CIRCULATIONAHA.110.971044

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 (patient closes eyes and holds both arms straight out for 10 seconds)

·         Normal—both arms move the same or both arms do not move at all (other findings, such as pronator drift, may be helpful)

·         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 slurring

·         Abnormal—patient slurs words, uses the wrong words, or is unable to speak

Note:  Interpretation: If any 1 of these 3 signs is abnormal, the probability of a stroke is 72%

The presence of all three findings indicates that the probability of stroke is > 85%

Circulation. 2010; 122: S818-S828 doi: 10.1161/​CIRCULATIONAHA.110.971044