For First Responders
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 procedures are the most effective treatment methods1.
- Smith, Eric E., and Lee H. Schwamm. "Endovascular Clot Retrieval Therapy."Stroke6 (2015): 1462-1467. Broeg-Morvay, Anne, et al. "Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke."Stroke47.4 (2016): 1037-1044.
Cincinnati Prehospital Stroke Scale (CPSS) is the required stroke scale in New York State but consider a possible stroke severity scale that will help to identify a large vessel stroke (large vessel occlusion).
Cincinnati Prehospital Stroke Scale (CPSS) + ED = FAST-ED
- Facial droop
- Arm/Leg weakness
- Speech Problems
- Eye Deviation -does the patient partially look to one side or do they have a forced eye deviation?
- Denial/neglect - does the patient seem to be ignoring one side of their own body when the stimulus is applied?
Posterior circulation stroke affects around 20% of all ischemic strokes and can potentially be identified by evaluating or assessing the “Five D’s”: Dizziness, drowsiness, dysarthria, diplopia, and dysphagia. Two or more of these signs could indicate a posterior circulation stroke.
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 pharmacy
- Prepares us for your arrival
Collaboration through Feedback and EMS Quality GroupUpstate 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 stroke 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 regional 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 workgroup will disseminate this information to our providers, impacting pre-hospital stroke care at the regional level. Download the brochure, EMS and STROKE, inspired by this group, highlighting this information.
Contact Josh Onyan, Stroke Program Manager at firstname.lastname@example.org for agency training opportunities.