first call of the day is...

Dispatched to a public assist/lift assist, which is non-emergent single engine no EMS response...a couple blocks away while sitting at a red light we see an EMS unit responding emergent turn down the street our call is on, pull up on scene a min later, sure enough they were at the same address completing refusal paperwork.
 
Jim37F said:
Dispatched to a public assist/lift assist, which is non-emergent single engine no EMS response...a couple blocks away while sitting at a red light we see an EMS unit responding emergent turn down the street our call is on, pull up on scene a min later, sure enough they were at the same address completing refusal paperwork.
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Least you didn't have to do anything!!!
 
A legit VAN positive stroke. Nearest neuro/cath was in downtown LA, right through Homeless Central. What a doozie...
 
NPO said:
Interesting. How does it compare to the LAPSS, CPSS, and RACE?
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They’re all testing for pretty much the same neuro deficits. The only difference is that VAN focuses on primary assessment of arm drift; if positive, continue with the rest. Mostly useful with large vessel occlusion.

Edit: we stuck around for the head scan, he had a good bleed to L hemisphere. Not big enough to drain, but big enough to shut down his R side.
 
Interesting.
We use CPSS and RACE.
CPSS being the qualitative scale, and RACE bring quantitative scale, mostly to identify LVO.
But, were doing away with RACE anyway.
 
NPO said:
Interesting.
We use CPSS and RACE.
CPSS being the qualitative scale, and RACE bring quantitative scale, mostly to identify LVO.
But, were doing away with RACE anyway.
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Cincinnati and RACE/FAST are way more comprehensive, VAN is used as a rough & dirty primary indicator. It tests for a major deficit and, if positive, a more in depth assessment is done. Suffice to say, if anyone uses VAN alone to ID a stroke, they’re eventually in for a big, nasty surprise.
 
That's why I tend to go with a MEND exam style assessment. If it is a left side looks like a wet noodle stroke, I might shorten it up a bit. But I've caught stuff before things like the Cincinnati would have been negative for by using a longer assessment.
 
StCEMT said:
That's why I tend to go with a MEND exam style assessment. If it is a left side looks like a wet noodle stroke, I might shorten it up a bit. But I've caught stuff before things like the Cincinnati would have been negative for by using a longer assessment.
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The MEND is my go to initial exam. I think starting something that will catch cerebellar involvement makes sense. Pretty easy for things to slip through a lot of the other screening tools, to the point that we now teach BLS to BE-FAST, with the B being balance and the E being eye (gaze) deviation (though that's more of an LVO thing). Things like RACE, CPSS, VAN, etc are meant to be used after a CVA is identified and more to drive destination decision in theory.

My regular job switched to making us do NIH scales. Bleh. Takes forever and is difficult. So I do the MEND for anyone I am vaguely suspicious of stroke for and if something is positive I can do the NIH during transport.
 
I'll look into MEND. The other day I had to explain to my EMT partner how I knew a guy was having a stroke when his CPSS was normal.
 
We use CPSS and VAN. If CPSS is positive AND there is arm drift proceed to VAN. But I have had the VAN miss LVO's. I have also had the CPSS miss CVA's that I have still called prehospitally that were LVO's.
 
Ground job we use mLAPSS. For my flight job we just use CPSS.
 
Medics here use LAPSS as far as I can tell. For us, first responder fire, they want us to test army drift, grip strength, feet push pulls, equal facial symmetry and that stuff, while the medics take all that, plus things like age, blood glucose, history, etc into consideration before calling a stroke alert or not.

We started going down that road yesterday on our first call of the day, came in as a seizure, 69 yo F, unconscious on arrival, opened eyes at her name but didn't really respond, pulse ox was 78%...started some high flow O2 and she started coming around and talking, initially only A&Ox1 to name, did those neuro checks ^ but they came up good. Idk if she was just postictal and hypoxic but by the time we got her into the ambulance she was talking and oriented 93 and generally a lot better off looking, so no stroke alert lol
 
Tigger said:
The MEND is my go to initial exam. I think starting something that will catch cerebellar involvement makes sense. Pretty easy for things to slip through a lot of the other screening tools, to the point that we now teach BLS to BE-FAST, with the B being balance and the E being eye (gaze) deviation (though that's more of an LVO thing). Things like RACE, CPSS, VAN, etc are meant to be used after a CVA is identified and more to drive destination decision in theory.

My regular job switched to making us do NIH scales. Bleh. Takes forever and is difficult. So I do the MEND for anyone I am vaguely suspicious of stroke for and if something is positive I can do the NIH during transport.
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I think it is a good blend. It's not so time consuming that it is unnecessarily long, but it is thorough. I can knock it all out in a couple minutes.
 
Jim37F said:
Dispatched to a public assist/lift assist, which is non-emergent single engine no EMS response...a couple blocks away while sitting at a red light we see an EMS unit responding emergent turn down the street our call is on, pull up on scene a min later, sure enough they were at the same address completing refusal paperwork.
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The question you should have asked them is, what were they dispatched for? They could have been dispatched for a fall, or an unconscious, or a person down. different people call 911 reporting different complaints..... even more fun when several people are all calling 911 from inside the same room with the different complaints, speaking to several call takers.

BTW, worked a shift last tuesday, where the toddler kept me up for most of the night..... ended up with a no hitter, and slept like a baby!!!
 
First call was an old man with a GI bleed. Transfusion made that better....90/60 P130 to 118/72 P80 and pinked up considerably. Field blood transfusions (low titer O Positive) are amazing.

Last call was a status febrile seizure 14 month old we intubated with an initial capno of 143.

It’s been a good day
 
First and only call last shift came at 0230. 92 yo F, slip and fall at home, bumped her head and tailbone. He of Dementia A&Ox1 as normal, EMS only really needed Basic Lifting Service from us, which was made much easier by the fact the house had an elevator! Tiny thing, but just large enough for the gurney in chair mode with someone accompanying. Def a big, swanky house. I was wondering if it was one of those places converted into mini SNF/care home, but only people we saw were the patient and her caretaker, so prob not. Def retirement goals lol
 
Industrial accident. A 40 y.o. M who was descaling/cleaning a silo, was wearing his safety harness but not clipped onto a safety line. Cue in nitrogen leak, he lost his balance & fell from anywhere between 30 to 50 ft, plus inhaled whatever fumes that the cleaning chemicals produced. Extremely difficult airway with a clenched jaw and frothy mouth, facial trauma, blown pupil in 1 eye and a nearly full deviation in the other, flail chest with a pneumo, plus rapid decompensation.
 
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