THE TEN PRINCIPLES OF PREHOSPITAL STROKE MANAGEMENT

1) EMS personnel should start 2-4 liters of oxygen via nasal cannula and monitor oxygen saturation.

2) Place an IV of normal saline (lactated Ringer’s solution is less preferable, but still better than a glucose-containing solution such
as D5W).

3) Avoid treatment of hypertension

4) Position patient to avoid aspiration and leave NPO.

5) Hyperglycemia and hypotension may cause the reversibly ischemic penumbra to become irreversibly infarcted tissue. Correct these rapidly.

6) Give glucose only if the patient’s fingerstick value is <50.

7) Obtain a history from any witness (including the name and telephone number of the witness).

8) Transport the patient with urgency to an appropriate health-care facility (one with a CT scan machine). If the patient is a potential candidate for t-PA, ask the ER physician overseeing transport if diversion to a stroke center is needed. If diversion is performed, notify the Stroke Center of a possible stroke patient while en route to the hospital.

9) Perform the brief neurological examination in the field, the Cincinnati Prehospital Stroke Scale (CPSS), but do not permit the performance of the exam to delay patient transport to the hospital.

10) Once in route, complete the MIAMI EMERGENCY NEUROLOGIC DEFICIT
(MEND/STROKE) exam and give the “TELEMETRY PRESENTATION” to the receiving ED. (see details of these on the EMS website.)

The Chattanooga Network for Stroke is eager to provide onsite training for your EMS. Please contact Karen Creel, R.N., at Erlanger Medical Center at 423-778-3842.

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