Cgabryszek: Created page with "'''''Goal scene time is less than 10 minutes.''''' {| class="wikitable" |'''EMR - Emergency Medical Responder''' |} # Perform an initial assessment, confirm ABCs ## Cervical spine precautions are to be taken if circumstances surrounding the event are not known or indicate a possible spine or head injury. # Begin initial medical care with emphasis on maintaining a functional airway ## Refer to the airway protocol ## Apply high-flow oxygen, if not already done ## If no..."

2022-04-03T22:11:26Z

Created page with "'''''Goal scene time is less than 10 minutes.''''' {| class="wikitable" |'''EMR - Emergency Medical Responder''' |} # Perform an initial assessment, confirm ABCs ## Cervical spine precautions are to be taken if circumstances surrounding the event are not known or indicate a possible spine or head injury. # Begin initial medical care with emphasis on maintaining a functional airway ## Refer to the airway protocol ## Apply high-flow oxygen, if not already done ## If no..."

New page

'''''Goal scene time is less than 10 minutes.'''''

{| class="wikitable"
|'''EMR - Emergency Medical Responder'''
|}

# Perform an initial assessment, confirm ABCs
## Cervical spine precautions are to be taken if circumstances surrounding the event are not known or indicate a possible spine or head injury.
# Begin initial medical care with emphasis on maintaining a functional airway
## Refer to the airway protocol
## Apply high-flow oxygen, if not already done
## If no spinal injury, may place in recovery position
## If unresponsive and accepts an oropharyngeal airway without a gag response, consider inserting a Supraglottic airway if trained to do so.
# Obtain SAMPLE history from witnesses
## It is crucial to identify the time of onset of symptoms based on when the patient was last known to be neurologically normal.

{| class="wikitable"
|'''EMT - Emergency Medical Technician''' ''Perform/Confirm All Above Interventions''
|}

# Perform and document a rapid neurological exam en route to the hospital.
## Report level of consciousness via AVPU scoring system
## Facial droop: Have patient smile
## Extremity weakness: Have patient hold up both arms
## Slurred speech: Have patient repeat the phrase “You can’t teach an old dog new tricks.”
## Check pupils
# For signs of Stroke, expedite transport and determine a LA Motor Score (LAMS):
## LAMS scores of 4+ suggests that the patient may have a Large Vessel Occlusion (LVO.)

{| class="wikitable"
! colspan="2" |LAMS SCORE
|-
|Facial Droop
|
|-
|Absent
|0
|-
|Present
|1
|-
|
|
|-
|Arm Drift
|
|-
|Absent
|0
|-
|Drifts Down
|1
|-
|Falls Rapidly
|2
|-
|
|
|-
|Grip Strength
|
|-
|Normal
|0
|-
|Weak
|1
|-
|No Grip
|2
|}

# If the LAMS score is 4 or greater, AND the patient’s symptoms have been present for less than 24 hours, they shall be transported to a comprehensive stroke center
## Comprehensive Stoke Centers include:
### St. Vincent’s Hospital
### Aurora BayCare Medical Center
## Bellin Hospital and St. Mary’s Hospital are NOT comprehensive stroke centers
## Patients with LAMS scores of <4 can be transported to the patient’s hospital of choice.
## If patient symptoms have definitely been present for > 24 hours, they can be transported to their hospital of choice.
## If a patient or their family insist on being transported to a non-thrombectomy ready facility, contact that facility as soon as possible for medical direction on how to best care for the patient.
## If a patient is deemed unstable, they should be transported to the closest emergency department regardless of thrombectomy capability.
# Perform glucometry en route and follow hypoglycemia protocol if indicated.
# If patient has an altered mental status or airway compromise, consider ALS intercept and treat according to the appropriate protocol.
# Apply cardiac monitor if trained to do so, print rhythm strip for reference.
# Notify receiving hospital of a “Stroke Alert” as soon as patient care safely allows, so they can consider activation of their Acute Stroke Protocol.

{| class="wikitable"
|'''AEMT – Advanced Emergency Medicine Tech ''' ''Perform/Confirm All Above Interventions''
|}

# Establish at least an 18 gauge IV in an antecubital fossa.
## The right antecubital fossa is preferred if possible.
# Administer normal saline at a TKO rate up to a total volume of 250mL.
# Manage airway as appropriate

{| class="wikitable"
|'''Intermediate -''' ''Perform/Confirm All Above Interventions''
|}

# Assess and treat any symptomatic dysrhythmia
# Document any seizure activity and treat per acute seizure protocol.

{| class="wikitable"
|'''Paramedic -''' ''Perform/Confirm All Above Interventions''
|}

2-10 ACUTE CVA (STROKE) - Revision history