For First Responders

For First Responders

EMS and Stroke 2017 Updates

Large Vessel Occlusion (LVO) is the new STEMI

LVO is a type of stroke where a major cerebral artery is blocked, much like how a major coronary artery is blocked with STEMI. LVO strokes have the highest rate of mortality and poor outcomes1. Thrombolytics (tPA) are the standard of care for acute ischemic stroke but may not work as a stand-alone treatment for LVO. Recent studies have shown that combined thrombolytics (tPA) and endovascular procedure are the most effective treatment methods1.

  • Smith, Eric E., and Lee H. Schwamm. "Endovascular Clot Retrieval Therapy."Stroke[1]6 (2015): 1462-1467. Broeg-Morvay, Anne, et al. "Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke."Stroke[1]47.4 (2016): 1037-1044.

Stroke Scales

Cincinnati Prehospital Stroke Scale (CPSS) is the required stroke in NYS. In addition, consider EYE DEVIATION as an indicator of LVO. Ask yourself, can your patient move both eyes equally or do they have a gaze preference to the left or right? Does your patient have full vision in both eyes or are they experiencing a vision loss in their visual fields. A positive CPSS in addition to eye deviation is highly indicative of LVO.

Cincinnati Prehospital Stroke Scale (CPSS)
  • Facial droop
  • Arm/Leg weakness
  • Speech Problems

       ***Only need one of these three signs to be considered CPSS potitive* 

Posterior circulation stroke effects around 20% of all ischemic sroke and can potentially be identified by evaluating or assessing the “Five D’s”: Dizziness, drowsiness, dysarthria, diplopia, and dysphagia.

Advanced Notification

Your pre-notification call begins the stroke chain of survival. Please include the following information:
  • EXACT time of onset/last known well
  • CPSS/alternate stroke scale findings
  • Blood Glucose value

**If possible, place two large bore IV’s for access to facilitate advanced imaging such as CT Angiogram. Also, include telephone contact information of next of kin and/or witness for additional questions/information.

What does your advanced notification do?

  • Activates the stroke team
  • Activates the CT scanners
  • Activates phamacy
  • Prepares us for your arrival

Collaboration through Feedback and EMS Quality Group

Upstate strives to provide quality feedback to each EMS agency on a consistent basis. Feedback for all patients brought to Upstate as a stroke or presumptive stoke will be delivered to agency representatives. Please see your agency quality director for specific feedback on patient treatment, diagnosis and discharge disposition, pre-notification call rates, and quality of the pre-notification calls.

In addition to timely feedback, Upstate has formed a reginal EMS Quality group. Our group meets monthly to discuss pertinent topics, as they relate to pre-hospital stroke care, in real-time. Group members from Central and Northern New York are able to bring topics and cases up for discussion in a nearly concurrent manner. The group has been able to identify and address important topics such as:

  • Documentation of the pre-notification call
  • What information to include in this call
  • Assessing for Large Vessel Occlusive strokes
  • Assessing for atypical stroke signs
  • IV size and placement

This work group will disseminate this information to our providers, impacting pre-hospital stroke care at the regional level. Download the brochure, EMS and STROKEPDF Icon, inspired by this group, highlighting this information.

For specific case questions or more information on our EMS Quality group, contact Josh Onyan, Stroke Program Outreach Coordinator, at onyanj@upstate.edu.

 

Training Opportunities

ENLS: Emergency Neurological Life Support

What to do in the first critical hour of a neurological emergency? The ENLS course is designed to help healthcare professionals improve patient care and outcomes during the critical first hours of a patient’s neurological emergency. ENLS demonstrates a collaborative, multi-disciplinary approach and provides a consistent set of protocols, practical checklists, decision points, and suggested communication to use during patient management.

MDs, critical care nurses, and other professionals who treat neurological emergencies benefit from ENLS's in-depth presentations of 13 critical topics including:

  • Ischemic Stroke
  • Subarachnoid Hemorrhage
  • Traumatic Brain Injury
  • Intracranial Hypertension and Herniation

Classes are held at Upstate University Hospital Downtown Campus in Syracuse NY. For more information visit www.neurocriticalcare.org/educationtraining/emergency-neurological-life-support-enlsExternal Icon or contact Jennifer Schleier, Stroke Program Manager at schleiej@upstate.edu.

Available class dates and times: October 20, 2017 and December 1, 2017 0800-1630
Instructors: Neurocritical Care Physician, Dr. Latorre
Cost of class: $75

 

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