Ischemic Stroke - Hennepin County Medical Center

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EMS Perspectives ________________________________________ Seventy-two percent of patients who have one abnormal finding on these three exam points may be experiencing an acute stroke. The patient is considered a possible CVA patient if any of the tested signs/symptoms are abnormal. The patient may be a candidate for thrombolysis (intravenous tPA) if any of the tested signs/symptoms are abnormal and onset of signs and symptoms began within 3 hours. Patients with ischemic stroke who are outside of the 3-hour window may be candidates for intra-arterial tPA or mechanical embolectomy, so timely hospital care is essential. Reference. Cincinnati Prehospital Stroke Scale (CPSS), Kothari, et al., Annals of Emergency Medicine, Volume 33, April 1999. Used with permission. _____________________________________________________ Figure One. Cincinnati Prehospital Stroke Scale for EMS Providers Transport. Even with the treatment window being expanded up to 6-12 hours from symptom onset, faster treatment is always better. Nearly two million brain cells die during each minute of a stroke. Rapid and safe transport to the closest appropriate facility is a key element of prehospital stroke care. Much like trauma and cardiac centers, many major hospitals are developing a “stroke center” model, which allows for rapid, definitive care of the acute stroke patient. When patients present with stroke in areas where a “stroke center” is not available, transport should be initiated to the closest facility capable of initial assessment and referral to a tertiary care center. In areas where ground transport of an acute stroke patient will not result in arrival at an appropriate hospital within the treatment window, aeromedical evacuation should be considered. Notification. Like trauma, STEMI, and other critical patients, it’s important to notify the receiving facility of an inbound patient with symptoms of acute stroke. This allows the facility to notify staff, reserve the appropriate procedure rooms, and prepare the computed tomograph (CT) scanner (a head CT is required prior to the administration of thrombolytics to ensure that the patient does not have a cerebral hemorrhage). Because “time is brain,” early notification of the receiving hospital allows the hospital-based team to prepare to reduce the other transitions in care that are necessary before treatment is started, such as door-to-CT time, door-to-CT-interpretation time, and CT-interpretation-to-treatment time. Because of their critical role in stroke care, EMS providers have an opportunity to provide patients with some of the biggest possible reductions in the time it takes for patients to be treated. This can be most successful with rapid response, early identification of acute stroke, early rule-out or management of hypoglycemia, and rapid transport to the closest appropriate facility, along with early notification to allow the hospital to mobilize resources. EMS providers may not provide definitive care, but they make definitive care effective in acute stroke. _____________________________________ * The treatments described summarize current practices in emergency care and serve as a guideline for prehospital care. EMS providers should defer to their agency’s medical director and standing orders if there is a discrepancy between this article and the agency’s current practice. __________________________________________________ 16 | Approaches in Critical Care | December 2008
Calendar of Events Class Descriptions Advanced Cardiac Life Support (ACLS) Provider This two-day course teaches paramedics, nurses, and physicians the essentials of cardiopulmonary resuscitation and emergency cardiac care as established by American Heart Association guidelines. Advanced Cardiac Life Support (ACLS) Provider Renewal This one-day review course teaches paramedics, nurses, and physicians the essentials of cardiopulmonary resuscitation and emergency cardiac care as established by American Heart Association guidelines. Advanced Cardiac Life Support (ACLS) for Experienced Providers This course is designed to provide experienced ACLS providers with new information on how to assess and manage critical cardiovascular emergencies not currently addressed in standard ACLS provider renewal courses. The course covers management of the standard ACLS core scenarios and focuses on four advanced areas of ACLS in 90- minute, interactive, small group sessions using a case-based format. These four areas are acute coronary syndromes, electrolytes, toxicology, and environmental emergencies. Emergency Medical Technician- Basic Course (EMT) This course is designed to train individuals to provide comprehensive emergency medical care at the basic life support level to victims of illness or injury. The course is an intensive three weeks of classroom, skills session, and clinical time. On completion of the course, students are prepared to function on a basic life support ambulance service. Certification as an EMT requires the successful completion of a national standard written and practical exam. EMT-Refresher Course This course is a review of the skills and knowledge covered in the EMT-Basic course. Attendance in an EMT-Refresher course and successful completion of practical testing every two years is required by the state to maintain EMT certification. Heartsaver AED This half-day course presents AHA CPR information and skills for the public are interested in learning CPR and AED use for adults, children, and infants. Upon completion of the course, the participant is issued an American Heart Association Heartsaver AED course completion card. First Responder Refresher This 16-hour course is a review of the skills and knowledge covered in the 40-hour First Responder course. Healthcare Provider CPR This half-day course presents AHA CPR information and skills for the healthcare professional. Upon completion of the course, the participant is issued an American Heart Association Healthcare Provider CPR course completion card. Trauma Nursing Core Course (TNCC) and Renewal (TNCC-R) The TNCC course is a two-day course, developed by the Emergency Nurses Association, that provides training in trauma management principles for registered nurses. To register for a course, visit www.hcmc.org and click on “Professional Education and Training.” For questions or additional information, contact Susan Altmann in HCMC Medical Education at 612-873-5681 or susan.altmann@hcmed.org unless another contact person is provided. Many courses fill quickly; please register early to avoid being wait-listed. Approaches in Critical Care | December 2008 | 17
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