Important Prehospital Interventions
There are several prehospital interventions that are included in Step #2 of the stroke algorithm. When implementing these interventions, emphasis should be placed on minimizing delay in transport of the patient to a facility with the appropriate level of care, and ideally, these interventions should occur during EMS transport.
Prehospital Interventions
- Support the patients airway
- Perform Cincinnati Prehospital Stroke Assessment (CPSS)
- Blood Glucose Check
- Establish Time Zero
- Triage and Alert Stroke Center
The stroke victim is at increased risk for airway compromise due to neurologic impairment. Ensure that the stroke victim’s airway is supported and supplemental oxygen is provided to maintain an oxygen saturation greater than 94%. If an oxygen saturation is not available, supplemental oxygen should be placed on the patient regardless of respiratory status.
The CPSS should be performed as discussed previously in Step 1.
Since hypoglycemia can mimic the symptoms of a stroke, a blood glucose check should be performed while en route to the emergency department.
It is important to attempt to establish the last known time that the patient’s neurologic status was normal. This is known as “time zero.” This helps to determine if the patient is a candidate to receive fibrinolytic therapy. Qualifications for fibrinolytic therapy will be discussed in more detail further down in the stroke algorithm.
If possible bring a witness (family member, caregiver, etc.) that can confirm the time of onset of the stroke symptoms.
As early as possible, it should be determined if the patient should be transported to a stroke treatment center.
Early notification to the stroke center, emergency department, or hospital will ensure that the receiving facility is prepared for the arrival and rapid treatment of the stroke patient.
RR Singh says
Your site is wonderful.
In resource limited countries/settings,can we use streptokinase for thrombolysis ?
Jeff with admin. says
Streptokinase should not be used.Streptokinase and Ischemic Stroke Articles
Kind regards,
Jeff
aslan says
Jeff
If time zero cannot be established, will this exclude the patient from fibrinolytic therapy even if he meets all other requirements?
Jeff with admin. says
Yes if it cannot be established at all then the patient would be excluded from fibrinolytic therapy. However, usually and realistically it can be established or at least approximated.
It is the physician’s discretion to realistically approximate given the history of the case. A physician could override a time if he thought there was any chance that the time limit was not exceeded significantly
Kind regards,
Jeff
Ita Sunday says
I did not hear you talk about B.P check while carrying out prehospital stroke intervention. Isn’t necessary?
Jeff with admin. says
The vital signs are not discussed here since they are a necessary part of the standard assessment for any patient no matter what their condition may be. Focus of these pages in strictly on Stroke protocol and assessment. Whether the patient’s blood pressure is high or low will not determine the course of stroke treatment. In the case where a patient is critical and needs ACLS intervention then you would use ACLS protocol in parallel with the ongoing stroke protocol.
Kind regards,
Jeff
Nguyen Van Truong says
When we see a victim with suspected of stroke? what is the best technique to move the patient? in condition that there is no equipment to transfer him we can bear him on shoulder or back?
Jeff with admin. says
If there is no evidence of trauma, a stroke victim can be moved as you would move any patient to ensure safety during transfer. The level of severity of the stroke would dictate to you how many people would be necessary for safety with any type of transfer. In normal circumstances EMS should perform transfers and therefore bearing a patient on your shoulder or back would not be necessary. In a situation where EMS services are not available, you would want to work toward ensuring the safety of the patient and any provider that is performing the transfer.
Kind regards,
Jeff
Truong says
Thank you very much for your reply, actually i am living in developing country Viet Nam where EMS is not available and Medical staff is not always ready to pick up patient as well, so most of the time family member must take patient to hospital. Therefore, i am just wondering about how the method of transfer can influence the condition of patient such as get worse significantly or not.
Jeff with admin. says
The method of transfer should not have any significant influence on the condition of the patient. Method of transfer should not make the patient any worse. The most important aspect is to reduce the time from stroke onset to initiation of fibrinolytic therapy.
Kind regards,
Jeff