+ Stroke Chapter 24 + Stroke Cereberovascular Accident Fourth leading cause of death in US Number one cause of long-term disability Estimated that 1 in 17 deaths are caused by stroke + Stroke- rapid or gradual nonconvulsive neurologic deficit that affects a vascular territory and results in local focal deficit.  Ischemic (87%) & Hemorrhagic  700,000 new/repat cases/yr  RF- smoking, high cholesterol, HF, Afib, DM, obesity + Stroke  Assessing time of onset of symptoms  Complete neuro assessment  PMH  Diagnostics-  Treatment- ABC’s - fibrinolytics,meds, + Assessment HPI- pain, provoking factor, food/activity, associated symptoms.  PMH- meds, preexisting illness.  Exam- LOC, temp, rash  Diagnostic- labs, xray, CT, EEG, LP  Management/evaluation- + Cincinnati Prehospital Stroke Scale + Los Angeles PreHosp Stroke Scale Screening Criteria Yes No 4. Age over 45 years ____ ____ 5. No prior history of seizure disorder ____ ____ 6. New onset of neurologic symptoms in last 24 hours ____ ____ 7. Patient was ambulatory at baseline (prior to event) ____ ____ 8. Blood glucose between 60 and 400 ____ ____ 9. Exam: look for obvious asymmetry Normal Right Left Facial smile / grimace: Droop Droop Grip: Weak Grip No Grip Weak Grip No Grip Arm weakness: Drifts Down Falls Rapidly Drifts Down Falls Rapidly Based on exam, patient has only unilateral (and not bilateral) weakness: 10. If Yes (or unknown) to all items above LAPSS screening criteria met: Yes No Yes No 11. If LAPSS criteria for stroke met, call receiving hospital with CODE STROKE, if not then return to the appropriate treatment protocol. (Note: the patient may still be experiencing a stroke if even if LAPSS criteria are not met.) + NIHHS Stroke Scale + Treatment Which patients are candidates for fibrinolytics? New “Stroke 7 Centers” D’s  Detection  Data Dispatch Delivery Decision Drug Door + Ischemic Stroke 87% of all strokes Include thrombolytic stroke, embolytic stroke, TIA A-fib is a high risk factor for cardioembolic stroke Need S/S less than 3 hours for fibrinolytics + Hemorrhagic Stroke  13% of all strokes  Intracerebral hemorrhagic stroke  10%  Hypertension is most common cause  Subarachnoid hemorrhagic stroke  3%  Common causes are aneurysm and AVM