Category Archives: Stroke Bypass

Question: In regards to the new BLS 3.0.1 under the paramedic prompt card for acute stroke protocol contraindications, it clearly states CTAS 2 and/or uncorrected airway, breathing or circulatory problem. My question in regards to this contraindication is does this automatically make a patient a CTAS level 1 when they are presenting with all signs and symptoms of a stroke and meet stroke protocol or does this mean that any other issues (i.e. chest pain making them a CTAS 2) puts them out of stroke protocol?

Question: Our current stroke directive reads that 3.5 hours is the timeline from time of onset to stroke center. The new BLS reads that the time from onset to stroke center is 4.5 hours. Which timeline are we expected to follow as of Dec 11th?

Question: In Elgin county we have been having trouble with our defibs spitting out 'noisy data' warnings on our 12 lead ECG's lately which has prompted conversation with crews about the STEMI protocol. Though the protocol clearly states that LP15 ECG software interpretation meets ***MEETS ST ELEVATION... some crews are saying that due to this issue with noisy data, we are able to interpret the ECG on our own and determine if it meets our criteria based on the >1 mm/or the >2mm ST elevation criteria. Your thoughts? Should we patch the cardiologist? Should we transport to nearest ED due to software not recognizing due to noisy data?

Question: Can you go stroke bypass with the only complaint being a defined onset of confusion?

Question: Recently we were on scene with an unresponsive 65 year old female. This was a witnessed event by a friend. While on route to the nearest ED patient’s condition improved. The patient started to answer questions. At this time the patient found to have left sided deficits. Should we continue to the local ED (5 min transport) or turn around for stroke bypass (50 min transport) After assessment in ED we ended up transporting to Stroke Unit.

Question: I have a question regarding a call done recently; dispatched to a 73 year old female patient, healthy, independently and living with husband; takes no medications and has no allergies. In recent past however, has had NYD syncopal episodes lasting up to 30 minutes, no residual deficits from events suffered.

At 08:10, patient had sudden onset of weakness, called husband who held her before she fell and gently lowered her down to floor while family member called 911. They thought patient was having yet another familiar syncope. No seizure activity witnessed.

Patient was found unconscious on floor. While on scene patient regained consciousness to a GCS of 14, she had left sided facial droop, left sided paralysis and slurred speech which has never been the case in past events. All other vital signs where within limits including BS.

Although patient had initial GCS of 3 (normal for patient's events) Would it have been prudent to consider these two as different events and include her as a Stroke protocol candidate given the clear time of onset, her history and the marked CVA like symptoms. Thank you.

Question: You are called to a retirement home for an 85 y/o female for a possible CVA. On arrival you are met by a Nurse Practioner who stated patient is having a stroke. Nurse Practioner also states that patient (who is a retired RN) has talked to her family doctor who agrees with patient's decision of not wanting to go to stroke centre or stroke protocol done. Patient has history of heart. Assessment reveals patient alert, orientated x 3 and meets stroke protocol. Patient wants to be transported to the local hospital for assessment. Does this patient or any patient have the right to refuse transport to a stroke centre?

Question: I recently did a call in which the patient was found by nursing home staff to be agitated and non-verbal with left sided arm paralysis. On EMS arrival the patient was moving all limbs but was still non-verbal and agitated. I also noted LT side neglect and some LT side facial drooping. The patient was last seen in a normal state at 04:30 and the time of our arrival was 08:30. The patient also had a valid DNR and I confirmed again with the POA on scene that it was still the wishes. By the time we loaded and transported the patient was outside the 4 hour mark for any CVA treatment. I returned to patient CTAS 3 as they were outside the time line and for the valid DNR. I am wondering if the patient had been within the 4 hour mark for treatment should this patient be returned CTAS 2 or would they still be CTAS due to the DNR? Thanks.

Question: If a patient has a valid DNR, can they still fall under the Stroke Protocol? I realize the protocol's contraindications list a palliative patient or terminally ill but does not address DNR. DNR in my point of view only applies to a patient who is dead, and wishes to not be resuscitated. Treatment for stroke at a proper facility could restore the patient's quality of life if such is affected by the stroke, and I feel they should still be included. I just wanted to verify.

Question: I have a question in regards to a specific situation with the Acute Stroke Protocol. We were called at 06:30 for an 85 year old female in a nursing home with slurred speech as witnessed by nursing staff. Upon our arrival she has a GCS of 15, blood glucose of 6.2 and obvious unilateral facial droop and pronounced associated slurred speech. The patient stated that she was up at 03:00 without concern which removed her from the Acute Stroke Protocol with all other criteria being met.

I understand that if the stoke symptoms resolve prior to our arrival the patient is not eligible for transport under the by-pass protocol. Additionally if their symptoms improve or resolve en route to a Stroke Centre transport should continue. However, en route her symptoms completely resolved and subsequently reoccurred – resolved again and while reporting to triage reoccurred in front of the staff at emerg.

After dialog with emerg staff I have the understanding that with completely resolved symptoms the "clock" would start (for them) with the onset of the recurrent (and witnessed) symptoms.

I would believe she would have the most appropriate care and best outcome being treated at a Stroke Centre. My question is twofold: first, is this a correct understanding of the possible in hospital treatment in way of assessing the initial onset of symptoms? Secondly, specifically for our transport decision could we use the recurrence onset of symptoms as the initial onset for meeting the Acute Stroke Protocol individually if it happened on scene or en route given we had equal distance to an ER or UH?

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