STROKE—What is new?

STROKE—What is new?

The American Heart Association has just published their newest Acute Ischemic Stroke (AIS) Guidelines.  Highlights can be found here:  http://professional.heart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_498645.pdf

Strokes are the second leading cause of death worldwide.  The disabling effects and cost associated with stroke victims is staggering.  While tPA is still the gold standard for ischemic strokes, mechanical  thrombectomy  to physically remove certain types of clots has been gaining traction with great results.

What does that mean for us?

We are already transporting directly to Stroke centers (VBGH, SLH, SPAH, CRMC), keeping our scene times short (10-15 min or less) and performing a stroke assessment.  We are calling early when our patient has any new stroke like symptoms, finding out when they were last seen normally, checking their blood sugar, obtaining a 12 lead, finding out when their symptoms started and bringing family along to the hospital (or at least a contact phone number).  We are often going straight to the CT scanner to shorten the testing process.

At this time, there are no changes that affect VBEMS.  In the coming months/years, we will likely see some destination changes, additional field scoring of stroke patients and more time specific goals.

Stroke items to remember:

  • Any new symptoms, no matter when they started, should be considered within the window for stroke treatment.
    • Time lines for receiving tPA and other interventions are stretching longer and longer (24 hours plus). If your patient has any stroke symptoms that are “new”, they should be rapidly transported directly to a stroke center.
  • Obtain time of symptom onset, when the patient was last seen “normal” (sometimes the time is the same), blood glucose, 12 lead, full sets of vital signs and of course perform your stroke scale.
  • Either bring a family member along or write down their phone number for the hospital.
  • Patients with new stroke symptoms should have a scene time of 10-15 minutes.
  • Contact the hospital as early as possible with your assessment, vitals and ETA.

Other links:

http://professional.heart.org/professional/ScienceNews/UCM_498579_2018-Acute-Ischemic-Stroke-Guidelines.jsp

http://tidewater.vaems.org/performance-improve-mainmenu-112/tems-triage-plans/tems-stroke-triage-plan/tems-stroke-triage-plan/file