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Medical

SUSPECTED STROKE / TIA

Signs and Symptoms: Differential Diagnosis:
• Altered Mental Status • Transient Ischemic Attack
• Weakness/Paralysis • Stroke
• Blindness or Other Sensory Loss • Seizure
• Aphasia/Dysarthria • Hypoglycemia
• Syncope • CNS Infection/Mass
• Vertigo/Dizziness • Trauma
• Vomiting • Metabolic
• Headache
• Seizures
Universal Patient Care Guideline
Continued from: O2 (if Hypoxemic)
Tactical Evacuation Guideline IV/IO Guideline 50% Dextrose 25g IV
Cardiac Monitor
OR

Glucagon 1mg IV/IM
Blood Glucose <60? YES
NO
Prehospital Stroke Scale: any 1 abnormal finding = Quick Neurologic Status:
72% chance of stroke GCS >8? AIRWAY Guideline
Facial Droop (show teeth and smile) Can protect airway? NO (maintain stable airway)
• Abnormal when one side of face does not move Can move all extremities?
equally with opposite side.
Arm Drift (close eyes and extend both arms) YES NO Intubated?
• Abnormal when one arm drifts down compared to Perform pre-hospital Stroke
opposite arm (arms move separately). Scale as able. YES
Abnormal Speech (say, “you can’t teach an old dog
new tricks”) 12-lead ECG Tachycardia
• Abnormal with slurred words, using wrong words, with Pulse
or unable to speak. (A-Fib)
Arrhythmia? YES
NO Bradycardia Cardiac Arrest
Consider Alternate Guidelines with Pulse (VF/Pulseless VT,
Asystole/PEA)
ALTERED MENTAL HYPERTENSION SEIZURE
STATUS
Pearls:
• Duration of symptoms should be determined as accurately as possible. Family members/colleagues can be helpful. If pt awaken with
symptoms–onset time est. from last time patient was seen “normal.”
• Be alert for airway problem/risk of aspiration. If concerned, request intubation before departure.
• Hypoglycemia can mimic stroke/TIA. May present with focal neurologic deficit, especially in the elderly.
• EKG should be obtained in all patients to evaluate for arrhythmia–especially atrial fibrillation.
• All TIAs should be transferred for evaluation, even if symptoms abated–these patients have a 10% risk of stroke within 30 days.
• Aspirin should not be given to patients for suspected stroke. Aspirin use is a contraindication to the use of thrombolytics for stroke.
• All strokes/TIAs are not associated with motor findings. Although uncommon, pure sensory strokes can occur. More frequently, very subtle
motor abnormalities are present that the patient may not note.
• Systolic greater than 185 or Diastolic greater than 110: give Labetalol 10-20mg IV for 1-2 minutes. May repeat 1 time.
• Aim for no more than a 20% reduction in MAP. MAP = [(2xDiastolic)+Systolic]/3
• For additional info see: ALS Acute Coronary Syndromes and Stroke.

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