Notes – Suspected Stroke/Transient Ischemic Attack

Suspected Stroke/Transient Ischemic Attack

Patient Safety Considerations

  1. Prevent aspiration – elevate head of stretcher 15-30 degrees if systolic BP greater than 100 mm Hg
    1. Maintain head and neck in neutral alignment, without flexing the neck
  2. Protect paralyzed limbs from injury
  3. Avoid multiple IV attempts

Notes/Educational Pearls

Key Considerations

  1. Transport and destination decisions should be based on local resources and stroke system of care
    1. Destinations hospitals may include:
      1. Primary Stroke Center
      2. Comprehensive Stroke Center
    2. Do not treat hypertension
    3. Place on cardiac monitor
    4. Pediatrics:
      1. Treatment principles remain the same
      2. Although rare, pediatric patients can have strokes
      3. Stroke scales are not validated for pediatric patients
      4. The EMS crew should call ahead to make sure that the hospital can manage the patient

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914145 – Medical-Stroke/TIA

Key Documentation Elements

  • “Last seen normal” must be specific
    • If the patient was last seen normal prior to bedtime the night before, this is the time to be documented (not time the patient woke up with symptoms present)
  • Blood glucose results
  • Specific validated stroke scale used and findings
  • Time of notification to receiving hospital

Performance Measures

  • Documentation of time “last seen normal”
  • Use of validated stroke score
  • Blood glucose level obtained
  • EMS scene time minimized (goal: less than 20 minutes)
  • Hospital stroke team pre-arrival alert or activation occurred as early as possible after positive stroke assessment finding
  • EMS Compass® Measures (for additional information, see http://www.emscompass.org)
    • Stroke-01: Suspected stroke receiving prehospital stroke assessment. To measure the percentage of suspected stroke patients who had a stroke assessment performed by EMS
    • Stroke-08: Emergency Department Diagnosed Stroke Identified by Prehospital Stroke Assessment. Measures the percentage of emergency department diagnosed stroke patients who had a positive stroke assessment by EMS
      • NOTE: This measure can only be evaluated if EMS documentation can be combined with information provided by the receiving hospital

References

  1. Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870-947.
  2. http://www.strokeassociation.org. Accessed August 28, 2017.