Cocaine Washout Syndrome

1
Pre-hospital Care in Stroke Todd J. Crocco,
MDDirector Division of EMS University of
Cincinnati Cincinnati, OH
2
Stroke Chainof Survival Recovery

• Detection
• Dispatch
• Delivery
• Door
• Data
• Decision
• Drug

3
Prehospital Stroke Survey

• Findings from a nationwide survey of paramedics
  and advanced EMTs
• TIA awareness is lacking
• Many felt strokes could be managed non-emergently
• Less than half were aware of the 3-hour time
  window

Crocco, PEC, 1999
4
EMS Evaluation of Acute Stroke

• Paramedic diagnosis of stroke/TIA correct in 72
  of cases
• EMS dispatchers correctly identify stroke/TIA in
  52 of cases
• ED evaluation and CT scan times shorter for ALS
  vs. BLS responses

Kothari, Stroke, 1995
5
The True Time of Onset

• Multiple sources
• Friends, family, bystanders
• EMS has unique opportunities to discover time of
  onset
• Times of reference
• The time the basketball game started
• How normal were they?
• Some patients will have previous neurologic
  deficits

6
Prehospital Stroke Assessment

• Cincinnati Prehospital Stroke Scale
• Los Angeles Prehospital Stroke Scale

7
The Impact Of 911
Barsan, Arch Int Med, 1993
8
Managing The Acute Stroke Patient

• Airway, Breathing, Circulation
• Assess vital signs
• Neurologic exam
• Check serum blood sugar
• Determine time of onset
• En route IV, O2, monitor
• Notify the ED quickly
• Transport as soon as possible

9
And Remember

• Do not delay transport
• Do not give large volumes of fluid (unless
  patient in shock)
• Do not give dextrose (unless hypoglycemic)
• Do not lower blood pressure
• Do not forget to determine time of onset

10
Stroke Treatment in 2000

• Increased public education
• Development of protocols and teams
• Pivotal and expanding role of prehospital care

11
Stroke Summary

• EMS personnel deserve more stroke education
• Always determine the time of onset
• Call early, transfer immediately
• Stroke is an EMERGENCY!