# unconscious stroke pt



## tegbay (Aug 10, 2007)

As title says, I just started class not long ago so dont bash me but when this situation arises, it says to place in recovery position, is that all you do for treatment, obviously check vitals cont. but if they have pulse,resp,and bp, all correct vitals just keep them in that position with high flow o2? thank you


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## MMiz (Aug 10, 2007)

First, welcome to EMTLife!

I wasn't taught to transport the patient in the recovery position.  I always had the patient reclined, keeping head and chest elevated.  If that fails, put them in the POC (position of comfort).  I'm basing this on the video I remember watching in EMT class, but it appears my local protocols back it up.

On the BLS level, you'd:
1.  Perform quick assessment
2.  Ensure ABCs
3.  Administer O2 via NRB
4.  Get SAMPLE history/Perform detailed full-body assessment (Especially check for trauma and medic alert bracelets).
5.  Assessment patient on Cincinnati Stroke Scale
6.  Transport to closest _appropriate_ hospital/stroke center
7.  Contact hospital ASAP with report

The one issue I always had on the BLS level was properly diagnosing a stroke in the pre-hospital setting, especially as a BLS provider.  I just didn't see it all that often, and it was never as pronounced as it appeared in the books/videos.  Because of that, I also would treat symptoms as they appeared.  I've had an MI/Stroke.  On my first call I confused a hypoglycemic patient for a stroke patient.  Thankfully my partner, ALS coming up the stairs, and even the police officer clued me in.

I hope that helps!


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## Ridryder911 (Aug 10, 2007)

It is all dependent upon the LOC of the patient. Recovery (lateral side, knee slightly flexed, with arm placed under to allow open airway) position is recommended for those that are unable to hold their head up or adequately expel secretions. Thus, preventing aspiration, and carefully watching airway, placing a NP or if tolerable OP and suctioning PRN. 

The head elevated is great for those with an increased LOC and can control their own airway, by increasing the head of the bed (H.O.B.) up to 30 degrees, one can lower the ICP quite a bit. Position of comfort is great, but if they are unresponsive the best is in the recovery position as again to prevent aspiration, which is very prominent in CVA patients (many loose gag and swallowing reflex).

Personally, I do not recommend memorizing all of the Cincinnati Stroke Scale. It was never intended or made for CVA screening, as many has eluded (even AHA was wrong endorsing this). This statement was made by one of the researchers and inventors of it. Its sole purpose was for epidemiological research only. There is a better scale, designed for prehospital and utilizes portion of the Cincinnati scale. 

I suggest those of advanced level to attend the Advanced Stroke Life Support (ASLS) Course. It goes into great detail on prehospital recognition and treatment. Courses, are taught for both prehospital and in-hospital criteria, with acknowledgement of both being essential. 

http://www.asls.net/introduction.html
R/r 911


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## Jhoira (Aug 11, 2015)

MMiz said:


> I wasn't taught to transport the patient in the recovery position.  I always had the patient reclined, keeping head and chest elevated.  If that fails, put them in the POC (position of comfort) ...



In _Prehospital Emergency Care,_ 9th ed., Mistovich and Karren have a complicated set of recommendations for positioning the stroke patient:

Needs ventilation?  Supine.
Responsive?  Supine or semi-Fowler at less than 30 degrees elevation.
Unresponsive (but breathing is adequate)?  Left lateral recumbent position.



MMiz said:


> On the BLS level, you'd:
> 1.  Perform quick assessment
> 2.  Ensure ABCs
> 3.  Administer O2 via NRB
> ...



Mistovich and Karren invoke the 2010 AHA guidelines when it comes to supplemental oxygen.  If the SpO2 is less than 94% (instead of the more common 95%), or the patient complains of trouble breathing, or has signs/symptoms of heart failure, mild to moderate hypoxia, or shock, use a nasal cannula at 2 to 4 lpm.  Only use non-rebreather if hypoxia is severe.

Of course, local protocols trump all this.


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## DesertMedic66 (Aug 11, 2015)

Keep in mind that this post was made in 2007. So the information here is outdated.


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## Jhoira (Aug 11, 2015)

Of course, which is why I updated it.  I found it on a Google search.


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