Brain Attack Inservice (EMS)
1. What significance does stroke (brain attack) have to our society?
• Third-leading cause of death.
• 150,000 deaths per year attributable to stroke.
• Leading cause of adult disability.
• Most preventable of all catastrophic conditions.
2. Be stroke smart
• Recognize symptoms: inability to walk, garbled speech, dizziness, loss of balance, weakness numbness or paralysis of the face, arm or leg, mental status change, blurred or decreased vision.
• Respond properly.
3. Initial EMS actions for stroke
• ABCs: Establish airway and administer oxygen by mask or nasal cannula at 2 liters per minute using normal saline (60 ccs per hour).
• Establish IV or saline lock using normal saline (60/hr) on all patients with recent onset of symptoms.
• Frequently monitor vital signs and neurological status (expect high pressures).
• Check blood glucose per protocol.
• Determine and document onset (the last time the patient was seen normal) of stroke symptoms.
4. EMS actions that should NOT be taken:
• Don’t delay transport.
• Don’t administer large amounts of fluid; it may contribute to brain swelling two to three days later.
• Don’t administer dextrose fluids unless the blood glucose is below 80.
• Exceptions to the above guidelines exist in case where symptoms of shock or hypoglycemia exist. Contact the receiving ED for orders.
5. Conditions that mimic stroke or are other potential causes of "stroke-like" symptoms:
• Hypoglycemia: This should be considered in anyone with altered mental status and neurological symptoms.
EMS — Check blood sugar.
• Epidural and subdural hematoma: Collections of blood under the skull.
EMS — Check for evidence of a fall.
• Brain abscess or tumor.
EMS — Check for elevated temperature or history of cancer.
• Post-seizure paralysis.
EMS — Obtain history and evaluate for evidence of a seizure.
Source: Mercy General Hospital, Sacramento, CA.
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