ACLS Cases – Acute Stroke

• Most strokes occur out of the hospital
• Patients with atrial fibrillation or hypertension are considered high risk patients
• Most patients do not recognize their stroke symptoms or try to explain them or deny they exist
• First goal = Early recognition of stroke symptoms
  • Sudden severe headache of unknown cause
  • Sudden weakness or numbness
  • Trouble speaking or understanding
  • Sudden confusion
  • Sudden trouble walking
  • Dizziness or loss of balance
• Use the Cincinnati Pre-Hospital Stroke Scale
  • If 1 finding is present, the chance of stroke is 79%.
  • If all 3 are present, the chance of stroke is >85%

Cincinnati Pre-Hospital Stroke Scale

Assess patient for the following (FAST):

F – Facial droop

Assessment: Have patient smile or show teeth

Result suggesting acute stroke: Crooked smile/face droops on one side

A – Arm drift

Assessment: Have patient close eyes and hold both arms out with palms up

Result suggesting acute stroke: Patient cannot hold both arms up (i.e. one arm drifts)

S – Speech

Assessment: Ask patient to say, “You can’t teach an old dog new tricks”

Result suggesting acute stroke: The speech is slurred

T – Time

        Time is brain! Ischemic stroke can be reversed if it is recognized and treated quickly