Pre Hospital stroke care at BLS level

shelvpower

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Hi Guys about a week ago I came upon a scene (off duty) where a car was stationary in the middle of the road.
As I arrived a LEO also arrived, I quickly pulles over to the side of the road and asked the LEO to divert oncoming traffic while I go and assess the situation. I found a male in his early 70's in the drivers seat with his wife next to him.

The wife told me that he started to lose consciousness and that she pulled up the handbrake (luckily it happened at a very slow speed).

I did a very quick assessment and told the LEO to contact a ambulance (eta 20 min) I did a stroke assessment and found that the patient indeed suffered a stroke. The wife also told me that he has had 2 strokes in the last year and a half.
Scene safety being a issue I decided to push the vehicle to the side of the road.
From then on I proceeded to monitor the pt's vital signs. HR was 120 and I unfortunately cant remember the BP.

The patient became quite combative and started refusing treatment, after a little persuasion from his wife he allowed me to monitor his vitals until a ambo turned up. I gave all the pt's information and findings to the medic and helped them to load the pt into the ambo.

I just want to know if there is anything I could've done more to help this patient seeing that I only have a level 3 first aid certificate behind my name (more or less equivalent to US first responder).
 

STXmedic

Forum Burnout
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Nope, nothing else to do for a stroke patient. Well done. Just be sure to keep your self safe on incidents like that.
 

Gurby

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Pretty much the only thing anybody can do for a stroke pt pre-hospital is gather history and do their best to get the pt to the appropriate facility.

Run through the fibrinolytic checklist to see if they are a candidate, are they on blood thinners, any possibility of head trauma, past history or family history of stroke / blood clots, are they showing signs of increased ICP, etc?

Determining the patient's mental baseline gets really hard with older patients (are they demented or not?), so if you can grab a family member and bring them along that's great.
 
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shelvpower

Forum Crew Member
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Pretty much the only thing anybody can do for a stroke pt pre-hospital is gather history and do their best to get the pt to the appropriate facility.

Run through the fibrinolytic checklist to see if they are a candidate, are they on blood thinners, any possibility of head trauma, past history or family history of stroke / blood clots, are they showing signs of increased ICP, etc?

Determining the patient's mental baseline gets really hard with older patients (are they demented or not?), so if you can grab a family member and bring them along that's great.

Can you please explain the fibrinolytic checklist for me?
 

NomadicMedic

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Did you ever check a blood sugar?

I think that's probably more valuable in this case than a lytic checklist. And a "stoke assessment" is in no way a definitive dx for stroke.
 

vcuemt

Ambulance Driver
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Did you ever check a blood sugar?

I think that's probably more valuable in this case than a lytic checklist. And a "stoke assessment" is in no way a definitive dx for stroke.
Can first responders in your area do that? Even many EMTs can't in certain parts of Virginia.
 
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shelvpower

Forum Crew Member
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I know how to do it and I may do it in the presence of a emt/paramedic but I may not do it without the presence of one
 

NomadicMedic

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Just another reason that EMS needs better training. An 85 year old woman can check her blood sugar, but an EMT can't?

Prehospital stroke care is "drive to expeditiously to a stroke center", the same for ALL levels of care. A paramedic may be needed to manage an airway, but in the majority of PT contacts, put them in the truck and drive to a place where they can do imaging and, if indicated, lytics.

It's of significantly more valuable to be able to identify and manage CVA mimics like hypoglycemia, electrolyte imbalances and sepsis.
 

cprted

Forum Captain
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Prehospital stroke care is "drive to expeditiously to a stroke center", the same for ALL levels of care. A paramedic may be needed to manage an airway, but in the majority of PT contacts, put them in the truck and drive to a place where they can do imaging and, if indicated, lytics.
Part of this could be changing in the future. My service is going to one of the trail sites for this new medication.

http://www.theglobeandmail.com/life...gram-with-toronto-paramedics/article18901898/

Of course, whether the trial drug is successful or not, we still need to provide efficient transport to a stroke centre.
 

NomadicMedic

I know a guy who knows a guy.
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NA-1 is not a definitive treatment for stroke. It may simply buy a little time to make the tPA therapeutic window larger. You would still put them in the truck and GO TO THE HOSPITAL QUICKLY.

Again... To clarify, stroke patients go into the truck and are driven with the quickness to a facility where they can spin their head!

Don't make this out to be more than it is. Outside of airway management for severely compromised patients, EMTs and Paramedics do not do anything of value for stroke patients aside from driving them to the ED. The ONLY medical treatment for an ischemic stroke is tPA. Your job is to drive them to the place where the tPA is. (This is one of the only times I would advocate use of lights and sirens to expedite the transport)
 

Brandon O

Puzzled by facies
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Strokes are BLS calls unless there's airway compromise or other secondary problems. Identify, transport to the right place, notify properly.

Not that there's much to do on the other end anyway (tPA is... less than thrilling), but it's a great practice run that includes many of the things that exemplify BLS care.
 

Angel

Paramedic
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They should be BLS but because of potential to deteriorate iv and blood sugar check (here) they are ALS.
I too agree EMTs should be able to do blood sugar checks
 
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