Stroke Assesment Sentence

BecomingaBetterEMT

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hey guys,

I know the book tells you when assessing at patient for a stroke to ask the patient to smile. Another trick is to tell the patient to repeat a sentence. I use, "The sky is blue in Cincinnati."

What do u guys use?
 

Ewok Jerky

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Slurred speech is slurred speech. You should be able to tell from regular conversation during your assessment. But I use "old dog new tricks" for practical exams, but not in real life.

Also if note: Slurred speech is a different point on the stroke scale from facial droop.
 

DesertMedic66

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Slurred speech is slurred speech. You should be able to tell from regular conversation during your assessment. But I use "old dog new tricks" for practical exams, but not in real life.

Also if note: Slurred speech is a different point on the stroke scale from facial droop.
This. It shouldn't take a special sentence for you to tell the patients speech is slurred. I do it over the course of my exam while having a conversation with the patient.
 
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BecomingaBetterEMT

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Slurred speech is slurred speech. You should be able to tell from regular conversation during your assessment. But I use "old dog new tricks" for practical exams, but not in real life.

Also if note: Slurred speech is a different point on the stroke scale from facial droop.


It got called out as a stroke. I would have to disagree with you when you said slurred speech is slurred speech. Not if the slurred speech isn't normal. It's like saying a patient's BP is in normal range. This is normal range
 

JPINFV

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Slurred speech is slurred speech. Just because it's normal for the patient for what ever reason (prior stroke, other neuro issue, lack of teeth, etc) doesn't mean it isn't slurred. Your job, as a clinician, is to determine if the slurred speech means anything or not.

Also, it doesn't matter what you get called out for. One of my med students recently repeated the ED's reason for admission for why we were admitting a patient, despite it being... well... wrong. I asked him who decides what the patient is going to be admitted for. He thought for a minute and then said, "We do." (we being the admitting team). Moral of the story, you decide what you're looking for and treating for... not the caller and not the dispatcher.
 

Aprz

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In Santa Clara County, they use BE FAST.

Balance - Move your finger while having the patient go back and forth touching their nose and your finger.
Eyes - Diplopia; Double vision
F - Facial symmetry
A - Arm drift
S - Speech
T - Time last seen normal

FAST is pretty standard throughout the nation. I guess it is sensitive for anterior (frontal) stroke, but not posterior (back) strokes. Santa Clara County added the BE part to catch posterior strokes. These patients may have dizziness and nystagmus.

I'll check their blood sugar (hypoglycemia, which is low blood sugar, can mimic strokes. Look up LA Prehospital Stroke Scale).

You can also do a MENDS exam, which is like a mini neuro assessment. There is a good article at the TheEMTSpot if you Google that (I'm on my phone).

I'll ask about nausea too.

Get GCS.

Get a line and transport. Monitor ABC.

Different areas have different protocols about stroke alerts. In Santa Clara, the patient has to be seen normal within 6 hours for them to be a stroke alert and transported code 3 to the nearest stroke center. If it is outside of that range, they are transported code 2 to the facility of their choice or their family choice.
 

DesertMedic66

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It got called out as a stroke. I would have to disagree with you when you said slurred speech is slurred speech. Not if the slurred speech isn't normal. It's like saying a patient's BP is in normal range. This is normal range
If the patient is talking normal then there is no slurred speech. If the patient is slurring words during my conversation with them that is slurred speech. It may be normal for the patient however it still needs to be noted. if my patient is slurring words while telling me their name Im not going to bother asking them to say "the lazy brown fox jumped over the tall dog house" or "Sally sells seashells by the sea shore".
 

RedAirplane

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Someone once told me never to use the "old dogs" sentence for geriatric patients. Apparently he had a bad experience there.
 

OnceAnEMT

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I'm curious, what do y'all do in the event that the Pt has no understanding of English what so ever, and you happen to have no clue how to speak their language, say, Spanish? Where saying "repeat after me" doesn't fly. Contingencies?
 

Ewok Jerky

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I'm curious, what do y'all do in the event that the Pt has no understanding of English what so ever, and you happen to have no clue how to speak their language, say, Spanish? Where saying "repeat after me" doesn't fly. Contingencies?
Ask family/bystanders if speech is slurred.
 

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