TIME IS BRAIN
Most EMS responders find themselves dealing with stroke patients at some point in their careers. Speed is of the essence when transporting a stroke patient, as well as knowing where to transport them for treatment with tPA, a clot-busting medication.
FDNY and New York City’s 911 system makes use of Mobile Stroke Units (running out of New York-Presbyterian, Weill Cornell Medicine, and Columbia University Irving Medical Center) which are equipped with the facilities to administer tPA often within the period to successfully treat a higher number of stroke victims before permanent damage is done to the brain. Currently, there are less than a dozen MSUs across the country.
In the meanwhile, responding EMS crews need to recognize the symptoms of stroke quickly. Using the Lifeline severity–based stroke triage algorithm, crews need to strive to deliver patients to appropriate stroke centers for treatment as early as possible. There have been “brain saving cases” where crews have called ahead to the nearest facility where clot-busting medication can be administered and transport to an appropriate stroke center can be arranged for advanced care.
Upon arrival at a suspected stroke victim, the crew should immediately begin a rapid and systematic assessment of the patient using the ABCDE approach. ABCDE stands for Airway, Breathing, Circulation, Disability, and Exposure. The ABCDE approach is a good way to assess all patients. A stroke causes an interruption of blood flow to the patient’s brain, and can kill brain matter. There are two types of stroke, Hemorrhagic (bleeding) and Ischemic (blood clot).
Some of the usual symptoms that a stroke victim will exhibit may include an inability to move or feel on one side of the body, problems understanding or speaking, dizziness, or loss of vision to one side. If the symptoms subside in an hour or so, the victim most probably suffered a TIA (transient ischemic attack) which may, or may not, lead to a full actual stroke within days. Transport to a medical facility is in the best interests of the patient.
Using the F.A.S.T. anagram, both responders and others can check for stroke symptoms. F – Does the face droop, is the smile crooked, does the patient’s face feel numb? A – Is one arm weak or numb, can the patient raise both arms equally? S – Is the patient’s speech slurred, or are they otherwise unable to speak? T – If these signs are evident, it is time to call 911 (for the laymen) or begin immediate transport to an appropriate medical facility. Patients who are transported by ambulance are generally seen before “walk-ins”.
When taking the patient’s history, it is important to know if they are on any anti-coagulant medications, suffer from high blood pressure or A-fib, has hypoglycemia or diabetes, and when they were last “known well”. There are some stroke mimics such as migraines, intoxication, and seizures… but even the slightest doubts need to be addressed in a hospital setting. During transport, check cardiac activity, using a monitor if available, and breathing; provide any necessary support en route.
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