Step 2: ACLS Stroke Protocol
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.
- 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.
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.