copyright 2009 seattle/king county ems overview of cbt 442 stroke complete course available at

Copyright 2009 Seattle/King County EMS

Overview of CBT 442 Stroke

Complete course available at www.emsonline.net


Introduction

Stroke • Advancements give hope for restoration of lost

neurological function

• Key is clot-busting therapy within 3 hours of onset

• Time lost is brain lost


Practical Skills

• Initial assessment (SICK/NOT SICK)

• Patient history

• Cincinnati Prehospital Stroke Scale

• Recognition of need for short scene times

• Care for stroke

To receive CBT or OTEP credit, you must perform the following practical skills:


Termsatherosclerosis - A condition characterized by the deposit of fatty plaques containing cholesterol and lipids on the innermost layer of the walls of large and medium-sized arteries.

embolism - A clot that travels from one part of the body to another until it becomes lodged in one of the small arteries of the brain and blocks blood flow.

hemorrhagic stroke - A type of stroke that occurs when a blood vessel bursts inside the brain.

infarction - A localized area of cell death due to a lack of oxygenated blood.


Terms, continued

ischemia - A deficiency of oxygenated blood in a body part as a result of a constriction or blockage of the blood vessel.

stroke (CVA) - A vascular disease that occurs when a blood vessel bringing oxygen to the brain bursts or is clogged by a blood clot or embolus. It can cause neurological deficits.

thrombus - A blood clot that typically forms over fatty plaque deposits that form on the inner wall of arteries. This plaque and subsequent narrowing may progress slowly, particularly in those patients who smoke or have high cholesterol or high BP.

transient ischemic attack (TIA) - A disorder of the brain in which brain cells temporarily stop working because of insufficient oxygen causing stroke-like symptoms that resolve completely within 24 hours of onset.


Three Regions of Brain• Cerebrum

• Cerebellum

• Brain Stem

Graphic illustration credit: LifeART(R) image, Copyright 1998, Lippincott Williams & Wilkins. All rights reserved.


Cerebrum

• Thought

• Personality

• Memory

• Motor skills

• Tactile (touch)

• Speech

• Vision

Three Regions of Brain, cont.



Cerebellum

• Coordination

• Balance

• Basic movement

• Muscle tone



Brain Stem

• Heart function

• Respiration

• Autonomic nervous system

• Digestion

• Glandular secretions


Types of Stroke

Ischemic: A blockage caused by a clot. This is the most common type of stroke.



Types of Stroke, continued



Hemorrhagic: A rupture caused by a break in a blood vessel. Less common than ischemic stroke but no less serious.

Hemorrhagic: A rupture caused by a break in a blood vessel. Less common than ischemic stroke but no less serious.


Thrombus

• Clot that develops at site of blockage

• Near area of plaque

• Causes a sudden occlusion

• Sudden onset of neurological deficits

Ischemic Stroke


Embolus

• Clot floats to site to form a blockage

• Circulates in bloodstream until it gets stuck in an artery

Ischemic Stroke, continued


Hemorrhagic Stroke

• Ruptured blood vessel on surface of the brain (subarachnoid)

• Ruptured blood vessel within brain (intracerebral)

• Puts pressure on the brain


Types of Stroke

Both types of stroke

Prevent oxygenated blood from reaching the brain tissues


Types of Stroke

Both types of stroke

Prevent oxygenated blood from reaching the brain tissues

May have only minutes to get patient to definitive treatment

Time lost is brain lost; seconds count.Time lost is brain lost; seconds count.


Transient Ischemic Attack

• Brain cells stop working because of insufficient oxygen

• Causes stroke-like symptoms that resolve completely within 24 hours


Risk Factors• Hypertension

• Smoking

• Age

• Gender

• Heredity

• Prior stroke

• Diabetes

• Carotid artery disease

• Heart disease

• TIAs


Signs and Symptoms

• Paralysis or weakness on one side of the body

• Facial droop on one side

• Altered level of consciousness

• Change in personality or mood

• Headache or dizziness

• Impaired speech

• Blurred vision

• Poor coordination


Initial Assessment

Determine SICK or NOT SICK early in the call

SICK or

NOT SICK?

SICK or

NOT SICK?


Physical Exam

A SICK patient is one who can die quickly unless you initiate aggressive BLS and ALS treatment and rapid transport.

A NOT SICK patient is one who can be ill or injured, but not severely enough to be life threatening.


Physical ExamKey Clinical Indicators

• Respirations• Pulse• Mental status • Skin signs and color • Body position

Relative to stroke

• Baseline vital signs • Cincinnati Prehospital Stroke Scale • Blood glucometry

SICK or

NOT SICK?

SICK or

NOT SICK?


Cincinnati Prehospital Stroke Scale• Accurate in identifying patients with stroke

• An abnormal finding in ANY three tests strongly suggests a stroke

Test Normal Abnormal

facial droop both sides of face move equallyone side of face does not move as well as the other

arm driftboth arms move same or both arms do not move at all (palms up, eyes closed)

one arm drifts down compared toother or one arm does not move

speechsays correct words with no slurring of words

slurs words, says wrong words, or is unable to speak


Patient 1

facial droop


Patient 1

facial droop

arm drift


Patient 1

facial drift

arm drift

speech


Patient 1

facial droop

arm drift

speech


Patient 2

facial droop


Patient 2

facial droop

arm drift


Patient 2

facial droop

arm drift

speech


Patient History

Stroke patients often report loss of motor function and/or a change in speech pattern. Some experience altered LOC.

SAMPLE history to determine if there is a history of:

• Hypertension • Blood thinners or anticoagulants • Arteriovenous malformation (AVM) • Cerebral aneurysm • Prior stroke


Patient History, continued

Chief complaint and time of onset are key in the Chief complaint and time of onset are key in the assessment of stroke.assessment of stroke.


Time of Onset• Determine time of onset but keep scene and

transport times short

• Be aware of time it takes for the hospital staff to assess and administer thrombolytic therapy

Clot-busting drugs must Clot-busting drugs must be givenbe given

within 3 hours of onset within 3 hours of onset of symptoms.of symptoms.


Care for Stroke

• Protect airway

• Ensure adequate respirations

• Remove secretions that can be aspirated

• Provide ventilation assistance

• Proper positioning

• Administer oxygen if saturation level is below 95% or there are signs of hypoxia


Short Scene Times

• Victims of stroke often deny or rationalize their symptoms

• Patients eligible for clot-busting drugs must be transported immediately

• Notify hospital that possible stroke pt is en route

• Avoid delays if patient waited before calling for help

Short scene and transport times are important.Short scene and transport times are important.


Summary

The three regions of the brain are cerebrum, cerebellum and brain stem.

The two basic types of stroke are ischemic (blockage) and hemorrhagic (rupture).

An ischemic stroke can be caused by a thrombus which is a clot that forms in a cerebral artery or an embolus which is a clot that travels to the brain.


Summary, continued

Signs and symptoms of stroke include:

• Paralysis or weakness on one side of the body

• Facial droop on one side

• Altered level of consciousness (from confusion to unconsciousness)

• Change in personality or mood

• Headache or dizziness

• Impaired speech


Summary, continued

The three tests of the Cincinnati Prehospital Stroke Scale are facial droop, arm drift and speech.

Determine time of onset of symptoms. This helps determine if a patient meets the three-hour window for clot-busting therapy.

Short scene and transport times are vital.

copyright 2009 seattle/king county ems overview of cbt 442 stroke complete course available at

Documents

ischemic stroke

blood clot

hemorrhagic stroke

brain bursts

stroke cva

brain cells

common type of stroke

blood vessel bursts