2-10 ACUTE CVA (STROKE)

Goal scene time is less than 10 minutes.

EMR - Emergency Medical Responder

1. Perform an initial assessment, confirm ABCs
   1. Cervical spine precautions are to be taken if circumstances surrounding the event are not known or indicate a possible spine or head injury.
2. Begin initial medical care with emphasis on maintaining a functional airway
   1. Refer to the airway protocol
   2. Apply high-flow oxygen, if not already done
   3. If no spinal injury, may place in recovery position
   4. If unresponsive and accepts an oropharyngeal airway without a gag response, consider inserting a Supraglottic airway if trained to do so.
3. Obtain SAMPLE history from witnesses
   1. It is crucial to identify the time of onset of symptoms based on when the patient was last known to be neurologically normal.

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Perform and document a rapid neurological exam en route to the hospital.
   1. Report level of consciousness via AVPU scoring system
   2. Facial droop: Have patient smile
   3. Extremity weakness: Have patient hold up both arms
   4. Slurred speech: Have patient repeat the phrase “You can’t teach an old dog new tricks.”
   5. Check pupils
2. For signs of Stroke, expedite transport and determine a LA Motor Score (LAMS):
   1. LAMS scores of 4+ suggests that the patient may have a Large Vessel Occlusion (LVO.)

LAMS SCORE
Facial Droop
Absent	0
Present	1
Arm Drift
Absent	0
Drifts Down	1
Falls Rapidly	2
Grip Strength
Normal	0
Weak	1
No Grip	2

1. If the LAMS score is 4 or greater, AND the patient’s symptoms have been present for less than 24 hours, they shall be transported to a comprehensive stroke center
   1. Comprehensive Stoke Centers include:
      1. St. Vincent’s Hospital
      2. Aurora BayCare Medical Center
   2. Bellin Hospital and St. Mary’s Hospital are NOT comprehensive stroke centers
   3. Patients with LAMS scores of <4 can be transported to the patient’s hospital of choice.
   4. If patient symptoms have definitely been present for > 24 hours, they can be transported to their hospital of choice.
   5. If a patient or their family insist on being transported to a non-thrombectomy ready facility, contact that facility as soon as possible for medical direction on how to best care for the patient.
   6. If a patient is deemed unstable, they should be transported to the closest emergency department regardless of thrombectomy capability.
2. Perform glucometry en route and follow hypoglycemia protocol if indicated.
3. If patient has an altered mental status or airway compromise, consider ALS intercept and treat according to the appropriate protocol.
4. Apply cardiac monitor if trained to do so, print rhythm strip for reference.
5. Notify receiving hospital of a “Stroke Alert” as soon as patient care safely allows, so they can consider activation of their Acute Stroke Protocol.

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Establish at least an 18 gauge IV in an antecubital fossa.
   1. The right antecubital fossa is preferred if possible.
2. Administer normal saline at a TKO rate up to a total volume of 250mL.
3. Manage airway as appropriate

Intermediate - Perform/Confirm All Above Interventions

1. Assess and treat any symptomatic dysrhythmia
2. Document any seizure activity and treat per acute seizure protocol.

Paramedic - Perform/Confirm All Above Interventions