Demo - Revision history

Treloars: /* Cincinnati Pre-hospital Stroke Exam (amended) */

2019-05-24T14:42:22Z

Cincinnati Pre-hospital Stroke Exam (amended)

← Older revision		Revision as of 14:42, 24 May 2019
Line 57:		Line 57:
	**Document that blood was drawn.		**Document that blood was drawn.
	*HYPERTENSION - Do not treat hypertension.		*HYPERTENSION - Do not treat hypertension.
	*Elevate the head of the stretcher 15-~~30degrees~~ if systolic BP >100 mm Hg		*Elevate the head of the stretcher 15-30 degrees if systolic BP >100 mm Hg
	*Do not allow aspiration		*Do not allow aspiration
	*Maintain head and neck in neutral alignment, without flexing the neck		*Maintain head and neck in neutral alignment, without flexing the neck

Treloars: /* Cincinnati Pre-hospital Stroke Exam (amended) */

2019-05-24T14:42:02Z

Cincinnati Pre-hospital Stroke Exam (amended)

← Older revision		Revision as of 14:42, 24 May 2019
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	\|<span style="color: deeppink;">Time </span>		\|<span style="color: deeppink;">Time </span>
	\|Time since – Last seen normal/Last Known Well (LKW)		\|Time since – Last seen normal/Last Known Well (LKW)
	~~(<span style="color: deeppink;">Only Needed for ER</span>)~~
	\|}		\|}

Line 67:		Line 66:
	**Is arm weakness present?		**Is arm weakness present?
	***<span style="color: deeppink;">YES - continue VAN assessment </span>		***<span style="color: deeppink;">YES - continue VAN assessment </span>
	***NO - Patient is VAN negative.		***NO - Patient is VAN negative.

	====VAN Assessment====		====VAN Assessment====

Treloars at 18:11, 19 March 2019

2019-03-19T18:11:12Z

← Older revision		Revision as of 18:11, 19 March 2019
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	{\| class="wikitable"		{\| class="wikitable"
	\|+DESTINATION SELECTION		\|+DESTINATION SELECTION
			\|-
			\|colspan="2"\|All suspected stroke and TIA patients must be transported to a stroke-receiving facility, unless the patient is UNSTABLE.
	\|-		\|-
	\|VAN Negative		\|VAN Negative
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	=====PRIMARY STROKE DESTINATIONS=====		=====PRIMARY STROKE DESTINATIONS=====
	~~All suspected stroke and TIA patients must be transported to a stroke-receiving facility, unless the patient is UNSTABLE.~~ The following hospitals have been approved by the Medical Director		The following hospitals have been approved by the Medical Director
	{\| class="wikitable"		{\| class="wikitable"
	\|Advent Health Altamonte		\|Advent Health Altamonte

Treloars at 21:08, 16 March 2019

2019-03-16T21:08:41Z

← Older revision	Revision as of 21:08, 16 March 2019
Line 118:	Line 118:


		{\| class="wikitable"
		\|+DESTINATION SELECTION
		\|-
		\|VAN Negative
		\|PRIMARY STROKE CENTER
		\|-
		\|VAN Positive
		\|COMPREHENSIVE STROKE CENTER
		\|-
		\|VAN NEGATIVE or POSITIVE and tPA EXCLUSIONS
		\|COMPREHENSIVE STROKE CENTER
		\|}

Treloars at 21:04, 16 March 2019

2019-03-16T21:04:57Z

Show changes

Treloars: Created page with "==Section 5 -MEDICAL== ===5.04 SUSPECTED STROKE/TRANSCIENT ISCHEMIC ATTACK (T.I.A.)=== ==== PRINCIPLES ==== Rapidly identify patients with suspected stroke Minimize scen..."

2019-03-16T20:19:13Z

Created page with "==Section 5 -MEDICAL== ===5.04 SUSPECTED STROKE/TRANSCIENT ISCHEMIC ATTACK (T.I.A.)=== ==== PRINCIPLES ==== *Rapidly identify patients with suspected stroke *Minimize scen..."

New page

==Section 5 -MEDICAL==
===5.04 SUSPECTED STROKE/TRANSCIENT ISCHEMIC ATTACK (T.I.A.)===

==== PRINCIPLES ====

*Rapidly identify patients with suspected stroke
*Minimize scene time & safe, expediate transport to the appropriate facility
*Continuous review and improvement on the stroke management process
*[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] 2.01
*Differential Diagnosis
**[[Altered_Mental_Status_(AMS)|ALTERED MENTAL STATUS (AMS)]] 5.03
**[[Sepsis_Septic_Shock|SEPSIS]] 5.17
*Establish a definitive last known well (LKW) time
*Complete a Cincinnati Pre-Hospital Stroke Exam

==== Cincinnati Pre-hospital Stroke Exam (amended) ====

*Cincinnati and VAN assessments can be performed simultaneously

Face

Arm

(VAN Positive or Negative?)

Speech

(VAN Aphasic? Consider VAN Visual Disturbance and Neglect!)

Time

Differential Diagnosis 5.03 ALTERED MENTAL STATUS (AMS)
5.17 SEPSIS
BLOOD GLUCOSE

STROKE CHECKLIST
Identify any t-PA exclusions and document all findings
Complete Stroke Checklist and leave copy at hospital
Forward or Fax the duplicate Stroke Checklist to County EMS QA office
A copy of the completed stroke checklist must also accompany the abbreviated report for the agency.

IV ACCESS: an 18 gauge is preferable. Avoid multiple attempts and IO's
Perform blood draw of all tubes. The crew shall hold onto the tubes at the hospital until a staff member is ready to label the blood tubes. Document that blood was drawn.
Notify ER staff and document location of any missed IV’s. **
Be conscientious of numerous IV attempts due to possibility of Fibrinolytic therapy and subsequent bleeding from both successful and attempted IV sites.
HYPERTENSION Do not treat hypertension

ELEVATE THE HEAD OF THE STRETCHER 15-30degrees if systolic BP >100 mm Hg Do not allow aspiration
-Maintain head and neck in neutral alignment, without flexing the neck
-Protect paralyzed limbs from injury
-Obtain 12-lead EKG
-Nausea/vomiting - administer an antiemetic

Have Patient hold both arms up for 10 seconds
Is arm weakness present? YES continue VAN assessment
NO Patient is VAN negative.

Visual

Aphasia

Neglect

ARM DRIFT PLUS ONE OF THE ABOVE IS VAN POSITIVE
Cincinnati and VAN assessments often are performed simultaneously
TRANSPORT DESTINATION (Determined ONLY by VAN Assessment Results)
Symptoms 5 minutes to >5 days called in as STROKE ALERT
Stroke receiving center can determine acuity and level of aggressive action.

Transporting EMERGENCY or NON-EMERGENCY is determined by the crew but <24 hours of LKW is recommended EMERGENCY transportation.

Use of air medical resources is appropriate when the window for evaluation for Intra-arterial therapy is less than 1-hour and ground transport exceeds 30 minutes.

COMPREHENSIVE STROKE DESTINATIONS:
Evaluation of suspected Large Vessel Occlusion (LVO) -or-
Have contraindications for IV therapy such as Coumadin therapy, recent surgery, treatment of bleeding ulcer, etc.

Advent Health Orlando - Comprehensive Stroke Care
Orlando Regional Medical Center - Comprehensive Stroke Care

PRIMARY STROKE DESTINATIONS:
All suspected stroke and TIA patients must be transported to a stroke-receiving facility, unless the patient is UNSTABLE. The following hospitals have been approved by the Medical Director:
Advent Health Altamonte - Primary Stroke Care
Advent Health Apopka - Primary Stroke Care
Advent Health East - Primary Stroke Care
Central Florida Regional Hospital - Primary Stroke Care
Orlando Regional Medical Center - Comprehensive Stroke Care
Oviedo Medical Center - Primary Stroke Care
South Seminole Community Hospital - Primary Stroke Care
Advent Health Orlando - Comprehensive Stroke Care
Winter Park Memorial Hospital - Primary Stroke Care

Demo - Revision history

Treloars: /* Cincinnati Pre-hospital Stroke Exam (amended) */

Treloars: /* Cincinnati Pre-hospital Stroke Exam (amended) */

Treloars at 18:11, 19 March 2019

Treloars at 21:08, 16 March 2019

Treloars at 21:04, 16 March 2019

Treloars: Created page with "==Section 5 -MEDICAL== ===5.04 SUSPECTED STROKE/TRANSCIENT ISCHEMIC ATTACK (T.I.A.)=== ==== PRINCIPLES ==== *Rapidly identify patients with suspected stroke *Minimize scen..."

Treloars: Created page with "==Section 5 -MEDICAL== ===5.04 SUSPECTED STROKE/TRANSCIENT ISCHEMIC ATTACK (T.I.A.)=== ==== PRINCIPLES ==== Rapidly identify patients with suspected stroke Minimize scen..."