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Stroke (Acute)
Inclusion Criteria: Patients suspected of having an acute stroke. Refer also to Trauma, arrhythmia, and
Altered Level of Consciousness guidelines.
Basic Level
- Assess and support ABCs.
- Place the patient in a position of comfort or in left lateral position. If evidence of shock, place the patient supine with the feet elevated and monitor airway closely. Treat shock according to the Shock guidelines.
- Administer oxygen as needed to maintain a SpO2 of at least 96%.
- Perform fingerstick blood glucose analysis and treat hypoglycemia, if present, per Altered Level of Consciousness guidelines.
- Medics should consider the presence of ANY of these signs evidence of an acute stroke:
a. Facial droop (ask the patient to smile - asymmetry of facial expression suggests facial droop)
b. Sudden asymmetry in neurological exam
c. Weak grip or loss of grip
d. Arm (pronator) drift (Hold the patient’s arms outstretched in front at shoulder level with the palms down. Have patient close eyes and let go of the arms. If one arm drifts downward, the test is
positive)
e. Sudden abnormal speech (Ask the patient to repeat a sentence or nursery rhyme. Slow or slowed speech or abnormal words suggests abnormal speech)
f. Sudden imbalance in walking
g. Acute arm or leg weakness
h. Sudden loss of vision (may be unilateral and patient may describe the vision loss like a “curtain”)
Advanced Level
- Apply ECG and monitor continuously until transfer of care to hospital staff. Treat arrhythmias under the
appropriate guideline. Apply EtCO2 monitor, if respiratory distress or shock is present or develops.
- Obtain 12-Lead ECG and consult with BioTel, as needed. Do not delay transport to obtain a 12-lead ECG.
- Establish IV access at a TKO rate or use a saline lock.
- Regardless of the duration of the symptoms, contact BioTel as soon as possible for transport destination.
- For additional patient care considerations not covered under standing orders, consult BioTel.
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