Drill of the Month Developed by Gloria Bizjak

1. Drill of the MonthDeveloped by Gloria Bizjak Assessing and Managing Stroke Patients

2. Assessing and Managing Stroke Patients Student Performance Objective: Given information, resources, and opportunity for discussion and practice, EMTs will be able to: • List risk factors of stroke, • List stroke signs • List patient care procedures, • Name stroke-care centers • Demonstrate patient care skills EMTs will follow acceptable Maryland Medical practice and Maryland Medical Protocols for Emergency Medical Providers. Drill of the Month

3. Assessing and Managing Stroke Patients Overview • Stroke Risk Factors • Stroke Signs • Patient Care Procedures • Stroke-care Centers • Skills Practice Drill of the Month

4. Stroke Risk Factors • Importance • To know in order to quickly recognize symptoms and determine potential medical problems • To learn during patient history to determine care Drill of the Month

5. Stroke Risk Factors • Types • Hereditary—not changeable • A function of natural processes; not changeable • Age and aging • Lifestyle—changeable, treatable • Diet • Sedentary life • Smoking Drill of the Month

6. Stroke Risk Factors • Unchangeable • Age—risk doubles for each decade after age 55 • Heredity (family history) and race • Higher risk if family member had a stroke • Higher risk if African American, Hispanic, Asian/Pacific Islander Drill of the Month

7. Stroke Risk Factors • Unchangeable • Sex (gender) • More common in men than in women • More women than men die of stroke • Special risk from use of birth control pills • Special risk from pregnancy • Prior stroke, TIA, heart attack Drill of the Month

8. Stroke Risk Factors • Treatable or controllable risk factors • High blood pressure • Treatment caused a decline in stroke death rates • Smoking • Damages cardiovascular system • Diabetes • Treatable, but increases stroke risk • Carotid artery disease (CAD) • Carotids supply blood to brain • Narrowed by plaque reduce/block blood flow Drill of the Month

9. Stroke Risk Factors • Treatable or controllable risk factors • Peripheral artery disease • Narrowing of vessels (by plaque) carrying blood to extremities • Causes higher risk of CAD • Atrial fibrillation • Quivering causes blood to pool and clot • Clots break off, lodge in artery to brain Drill of the Month

10. Stroke Risk Factors • Treatable or controllable risk factors • Other heart disease • CAD • Heart failure • Enlarged heart • Heart valve disease • Some congenital heart defects Drill of the Month

11. Stroke Risk Factors • Treatable or controllable risk factors • Sickle-cell disease/anemia • Affects African-American and Hispanic children • Sickled red cells less able to carry oxygen • Cells stick to vessel walls, block arteries, reduce flow to brain Drill of the Month

12. Stroke Risk Factors • Treatable or controllable risk factors • High cholesterol • Poor diet • High in saturated fat, trans fat, cholesterol • High in sodium increases blood pressure • High calorie intake contributes to obesity • Physical inactivity (sedentary living), obesity Drill of the Month

13. Stroke Risk Factors • Treatable or controllable risk factors • Other possible risk factors • Geographic location • Common in southeast US (stroke belt states) • Socioeconomic factors • Common in low income people • Alcohol abuse • Leads to multiple medical complications, including stroke • Drug abuse • Associated w/societal, health related problems, including stroke Drill of the Month

14. Stroke Signs • General (important to learn during patient history) • Sudden numbness or weakness • Face, arms, legs • Sudden confusion • Trouble speaking or understanding others • Sudden trouble seeing in one or both eyes • Sudden trouble walking • Dizziness or loss of balance or coordination Drill of the Month

15. Stroke Signs • Cincinnati Prehospital Stroke Scale • Three simple signs: First 3 letters of STRoke • Per Maryland Protocols • Important: Have patient demonstrate • S Can patient SMILE—facial droop one side • T Can patient TALK or say a simple coherent sentence—abnormal speech • R Can patient RAISE both arms straight outin front without arm drift Drill of the Month

16. Stroke Signs • Other possibly reliable sign • Crooked tongue • Ask patient to stick out tongue • If it goes to one side or another, it is a possible indication of stroke • Possible reliable sign • Difficult to interpret how far to one side or other Drill of the Month

17. Patient Care Procedures • Based on Maryland Protocols • Initiate general patient care • Arrival and size-up • Patient approach • Initial assessment • Mental status • A,B,C,D,E • Clinical priority (1,2,3,4) • Disposition (mode, status) • History and physical exam/assessment Drill of the Month

18. Patient Care Procedures • Treatment • Presentation • Signs and symptoms (recall stroke signs) • Seizures or altered mental status • Patient care • Oxygen at 2-6 liters via nasal cannula • Lay patient flat or slightly elevated Drill of the Month

19. Patient Care Procedures • Treatment • Patient care: Recall Fibrolintic Therapy Checklist • All yes/no boxes checked for transport to designated stroke center • Inclusion (yes) criteria • 15 years of age or older • Signs and symptoms of stroke with neurologic deficit (abnormal Cincinnati Prehospital Stroke Scale) • Patient can be delivered to stroke center w/i 2 hours of signs/symptoms of onset Drill of the Month

20. Patient Care Procedures • Treatment • Patient care: Recall Fibrolintic Therapy Checklist • All yes/no boxes checked for transport to designated stroke center • Exclusion (no) criteria • Active internal bleeding (e.g., gastrointestinal bleeding or urinary bleeding w/i 21 days of onset) • Known bleeding disorder • Intracranial surgery, serious head trauma, previous stroke w/i 3 months • Major surgery or serious trauma w/i 14 days • History of intracranial hemorrhage • Witnessed seizure at stroke onset • History of cancer of the brain Drill of the Month

21. Patient Care Procedures • Treatment • Patient care • Consult w/nearest designated stroke center • Rapid transport • Hospital must have time to prep for patient • Stroke treatments are time sensitive • Patients benefit from thrombolysis and interventional therapies • Administration of tissue plasminogen activator (t-Pa), or fibrolinic therapy, a clot busting drug, can reverse effects of stroke Drill of the Month

22. Stroke Centers • Refer to Maryland Protocols • Anne Arundel Medical Primary Stroke Center • Atlantic General Hospital Primary Stroke Center • Baltimore Washington Medical Primary Stroke Center • Calvert Memorial Hospital Primary Stroke Center • Civista Medical Primary Stroke Center • Franklin Square Hospital Primary Stroke Center • Good Samaritan Hospital Primary stroke Center, MD Drill of the Month

23. Stroke Centers • Refer to Maryland Protocols • Greater Baltimore Medical Primary Stroke Center • Harbor Hospital Primary Stroke Center • Harford Memorial Hospital Primary stroke Center • Holy Cross Hospital Primary Stroke Center • Howard County General Hospital primary Stroke Center • Johns Hopkins Bayview Medical Primary Stroke Center • Johns Hopkins Hospital Primary Stroke Center Drill of the Month

24. Stroke Centers • Refer to Maryland Protocols • Maryland General Hospital Primary stroke Center • Memorial Hospital and Medical Center of Cumberland, Inc. Primary Stroke Center • The Memorial Hospital at Easton, MD, Inc. Primary Stroke Center • Montgomery General Hospital primary Stroke Center • Peninsula Regional Medical Center Primary stroke Center • Saint Agnes hospital Primary Stroke Center • Saint Joseph Hospital Primary Stroke Center Drill of the Month

25. Stroke Centers • Refer to Maryland Protocols • Saint Mary’s Hospital Primary stroke Center • Shady Grove Adventist Hospital Primary stroke Center • Sinai Hospital of Baltimore Primary Stroke Center • Southern Maryland Hospital Primary Stroke Center • Suburban Hospital Association Primary Stroke Center • Union Memorial Hospital primary Stroke Center • University of Maryland Medical System Primary Stroke Center Drill of the Month

26. Stroke Centers • Refer to Maryland Protocols • Upper Chesapeake Health System Primary Stroke Center • Washington Adventist Hospital Primary Stroke Center • Washington County Health System Primary Stroke Center Drill of the Month

27. Skills Practice • Patient Care Procedures (per Protocols) • Initiate general patient care • Arrival and size-up • Patient approach • Initial assessment • Mental status • A,B,C,D,E • Clinical priority (1,2,3,4) • Disposition (mode, status) Drill of the Month

28. Skills Practice • Patient Care Procedures (per Protocols) • Treatment • Presentation: Recognize signs; treat accordingly • Consult with and notify hospital • Rapid transport Drill of the Month

29. Assessing and Managing Stroke Patients Student Performance Objective: Given information, resources, and opportunity for discussion and practice, EMTs will be able to: • List risk factors of stroke, • List stroke signs • List patient care procedures, • Name stroke-care centers • Demonstrate patient care skills EMTs will follow acceptable Maryland Medical practice and Maryland Medical Protocols for Emergency Medical Providers. Drill of the Month

30. Assessing and Managing Stroke Patients Review • Stroke Risk Factors • List types of risk factors • List unchangeable risk factors • List treatable or controllable risk factors • List other possible risk factors • Stroke Signs • List general signs • List the 3 signs of the Cincinnati Prehospital Stroke Scale • List other possible reliable signs • Patient Care Procedures • List general patient care procedures • State patient treatment steps • Stroke-care Centers • List stroke centers in your response area • Skills Practice • List skill steps demonstrated during practice in caring for stroke patients Drill of the Month