Recognizing Stroke

ARC_FAST_graphicSeveral weeks ago (well, over a month now) I was approached by the American Recall Center (go check them out!) about publishing a Code Stroke/Stroke Awareness post. If you’ve noticed, I’m super slow on getting things out because when I’m not working I’m usually dead to the world.

Collectively, we’ve done a pretty good job on training and awareness in cardiac issues related to acute coronary syndromes. Cardiology education and 12 lead training and skill expansion has become the standard in paramedic education. Now the pivot has been to strokes/CVA. Let’s look at some CDC statistics:

  • Stroke kills 130,000 people every year
  • There is a death every 4 months on average
  • 795,000 strokes a year
  • 610,000 are first time/new strokes
  • One in four strokes are recurring
  • 87% of all strokes are ischemic
  • Stroke is a leading cause of disability
  • Stroke care costs $36.5 billion dollars a year

Other statistics show that stroke is more prevalent in the African American community and, which lines up with the trend of the most strokes being in the southeastern US.

EMS Recognition

It’s highly likely that with the high level of interaction during holiday periods, you will inevitably be called for a stroke or stroke like symptoms. It’s important for you to search for treatable causes (quickly) in order to at least make the list of differential diagnosis shorter. Time allowing, blood glucose analysis and 12 lead ECG should be performed in order to screen out cardiac issues and diabetic problems. If you have the ability to test lactate, sepsis should be screened for. In the absence of sepsis, diabetic problems, or cardiac issues, stroke should be considered.

The standard for EMS bedside tests has been the Cincinnati Prehospital Stroke Scale (CPSS), which is 72% sensitive in detecting ischemic stroke when at least 1 of the criteria is present and is 85% sensitive when all three criteria are present. To review, those criteria are:

  • Arm drift
  • Facial droop
  • Slurred or unrecognizable speech

As in any test, the more criteria you add, you begin trading sensitivity for time to perform. A CPSS can take seconds to perform, however, the recent push has been for the MEND test. MEND is an acronym for Miami Emergency Neurologic Deficit. The MEND checklist pushed during the ASLS class includes:

  • Mental status
  • Cranial nerves
  • Limbs
  • History
  • T-PA exclusions
  • Management

Check out ASLS on how to order the checklist and there’s even an app for that, too.

Public Education

The biggest part of our response, however, is getting people to figure out when to call. So, like with cardiac emergencies, early recognition by the public is important in activating the emergency response system. Our efforts should focus on teaching the basics of the prehospital stroke scale and getting the public to remember the key points, and call 911 when that occurs. This is where the American Recall Center came into play. They provided a graphic you can use and post in public places, hand out, etc, in order to get the word out about stroke.

Conclusion

Stroke is a major killer of Americans, and fast recognition by EMS and delivery to the ED is critical, but FASTER recognition by the public at large is key to our response. Our efforts shouldn’t only focus on EMS stroke recognition but public education about stroke in the same way we educate about heart attacks, sudden cardiac arrest, and Hands-Only CPR.

Resources

  1. http://www.ncbi.nlm.nih.gov/pubmed/11789659
  2. http://labtestsonline.org/understanding/analytes/ldh/tab/test
  3. http://en.wikipedia.org/wiki/Cincinnati_Prehospital_Stroke_Scale
  4. http://asls.net/mend_about.php

This article was written by rstine