Category Archives: Stroke Bypass

I recently attended a CVA/TIA related call; it had been the first CVA related call I had been to since having a 4-year hiatus out of the trucks. Since being out the trucks the CVA consult/bypass protocol has been implemented. I'm having a difficult time understanding the point of the consult. If the Paramedic on scene is able to identify CVA symptoms accurately/appropriately, why are we delaying transport to discuss with a physician, who is not on scene, if we should transport to the appropriate stroke facility? It was explained to me that Paramedics weren't correctly identifying CVAs pre-hospital. If that's the case, those that aren't recognizing a CVA aren't performing a consult because they didn't recognize the CVA in the first place. If I can identify a CVA correctly, announce a code stroke to dispatch, and have the stroke team ready on our arrival, how can there be any benefit to calling someone who knows nothing about the incident other than what I tell them? What is the difference between a doctor incorrectly identifying the CVA over the phone versus the Paramedic incorrectly identifying the CVA on scene other than the 15 minutes saved not trying to call for a consult? There also seems to be some significant discrepancies as to the onset of symptoms time frame between different receiving hospitals and physicians. Our destination guidelines clearly state within 6 hrs of onset of symptoms; however, recently a fellow medic advised me that it was 8 hrs but our guidelines have not yet been changed to reflect this, and a physician told me the window is 12 hrs. Any clarification/suggestions/info would be greatly appreciated. Thank you so much!

What is the rule for stroke bypass when symptoms resolve on scene? It doesn’t specify for this scenario in the directive, and only says “continue to bypass if symptoms resolve on transport”. In this case our patients had stroke symptoms for 1-2 minutes that quickly resolved and he no longer had any symptoms. What is the most appropriate hospital in this scenario?

In regards to the LAMS score, is it to be used for acute changes only if a patient has deficits from a previous stroke? For example, if the patient already has a weak grip and arm drift from a previous stroke with no reports of acute changes, however they have facial droop that is reported to be new then is only the one point for facial droop counted?

Are there any tools that we can use to differentiate Bell’s palsy from a CVA to prevent us from an unnecessary 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.

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