It s Not All One Sided James Smith, MD (Smitty)
Disclosures Chair, NE State EMS Board Medical Director, Emergency Services, GPH Medical Director, GPH LifeNet, NPFD, Maxwell, Tryon, Chase County, NP Rec Center Member Board of Directors, GPH Co-Owner/Medical Director, Priority Medical Transport
Learning Objectives Participant will understand the impact that strokes have on our national and state finances. Participant will be able to identify stroke signs and symptoms. Participant will be introduced to the RACE stroke scale and understand how it relates to pathophysiology.
Stroke Facts Stroke is the 5 th leading cause of death in the US. 130,000 cases in 2009. Stroke is a leading cause of long-term disability and the leading preventable cause of disability. Median Stroke survivor in US in 2010 was 6.8 years. Estimated cost of 36.5 billion dollars in 2010 in the US.
Stroke Facts American Heart Association predicts stroke prevalence to increase by nearly 25 % by 2030. Total hospital charges for stroke in Nebraska increased from $ 54,000,000 to $ 108,000,000 from 2001 to 2010. Average charge per stroke hospitalization in NE was $ 31,000 in 2010. 2011 Nebraska Heart Disease and Stroke Prevention Program and Data Summary by the Nebraska Department of Health and Human Services
Stroke Facts One in three stroke emergencies don t use EMS. During a stroke emergency, quick treatment is critical. Patients with ischemic strokes who receive tpa are more likely to recover fully or have less disability than patients who do not receive the drug.
Stroke Facts Patients treated with tpa are also less likely to need long-term care in a nursing home. Unfortunately, many stroke victims don t get to the hospital in time for tpa treatment. For each minute a stroke goes untreated and blood flow to the brain continues to be blocked, a person loses about 1.9 million neurons, 14 billion synapses, and accelerated aging of 3.1 weeks. For each hour; lose 120 million neurons, 830 billion synapses, and accelerated aging of 3.6 years.
The Need for Speed EMS is the fastest way to get there, according to research in Circulation: Cardiovascular Quality and Outcomes http://circ.ahajournals.org/ strokeassociation.org
Stroke Pathophysiology
Risk Factors for Stroke Hypertension Smoking Diabetes Alcohol Obesity/Inactivity Cholesterol Diet Atrial Fibrillation Race Age Gender Family History/Genetics Bleeding/Clotting Disorders TIA or Previous Stroke
Angiogram
Types of Stokes Ischemic account for 87 % of all strokes An ischemic stroke occurs when a blood vessel that supplies the brain becomes blocked or "clogged" and impairs blood flow to part of the brain. Thrombotic Clot or blockage develops inside the brain blood vessels themselves. Embolic Clot or plaque develops in vessels outside the brain and travels to vessels in the brain via the blood stream Hemorrhagic account for remaining 13 %
Thrombotic
Embolic
Transient Ischemic Attack TIA
Hemorrhagic
Homunculus
Stroke Sign and Symptoms Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body Sudden confusion, trouble speaking, or difficulty understanding speech Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance, or lack of coordination Sudden severe headache with no known cause
Stroke Sign and Symptoms
Stroke Guideline
Cincinnati Stroke Scale
LA Pre-hospital Stroke Scale
New Stroke Assessment Tool RACE Rapid Arterial occlusion Evaluation
RACE
Pearls
Facial Facial Ask the patient to show their teeth Result (smile) Score Absent (Symmetrical movement) 0 Mild (slight asymmetrical) 1 Moderate to Severe (completely asymmetrical) 2
Arm Motor Function Result Arm Motor Function Normal to Mild (limb upheld more than 10 seconds) Moderate (limb upheld less than 10 seconds) Severe (patient unable to raise arm against gravity) Extending the arm of the patient 90 degrees (if sitting) or 45 degrees (if Supine) Score 0 1 2
Leg Motor Function Leg Motor Function Extending the leg of the patient 30 degrees (if Supine) Result Normal to Mild (limb upheld more than 5 seconds) Moderate (limb upheld less than 5 seconds) Severe (patient unable to raise arm against gravity) Score 0 1 2
Head & Gaze Deviation Head & Gaze Deviation Observe eyes and head deviation to one side Result Absent (eye movements to both sides were possible and no head deviation was observed) Present (eyes and head deviation to one side was observed) Score 0 1
Aphasia Aphasia Difficulty understanding spoken or written words. Ask patient to follow two simple commands: 1. Close your eyes 2. Make a fist Result Normal (performs both tasks requested correctly) Moderate (performs only 1 of 2 tasks requested correctly) Severe (cannot perform either task requested correctly) Score 0 1 2
Agnosia Result Agnosia Normal (recognizes arm, and attempts to move arm) Moderate (does not recognize arm or is unaware of arm) Severe (does not recognize arm and is unaware of arm) Inability to recognize familiar objects. Ask patient : 1. Whose arm is this? (while showing the affected arm) 2. Can you move your arm? Score 0 1 2
smithje@gphealth.org
Thank you!