Stroke Triage: EMS needs a diagnostic tool that goes beyond a simple history & physical exam

As a young EMT and paramedic, I had relatively little education about acute myocardial infarctions. In the age of the 3-lead ECG, education was largely focused on arrhythmia detection and how to differentiate heart blocks, tachycardia and bradycardia. Detection of heart attack was largely based upon history and physical exam findings. Three decades later, the thought of relying on a physical exam to diagnose a ST- elevation myocardial infarction (STEMI) is hard to imagine. Although we’ve made remarkable progress in the prehospital detection of STEMI, we’ve made significantly less progress in the diagnosis of acute stroke. Identification Systems Our initial focus on triage for stroke was the simple identification of stroke vs. stroke mimic, followed by establishment of systems for prehospital activation of stroke centers. Our goal was to get patients to a center where they had established teams that could rapidly evaluate patients, provide a CT scan of the head to differentiate hemorrhagic from ischemic stroke, and administer intravenous fibrinolytics, such as tPA. There have been multiple hospital and prehospital scoring systems to aid in the diagnosis of stoke and determination of stroke severity. Since the mid-1990s, the gold standard for evaluation of stroke has been the NIH Stroke Severity score. This 15-factor, 42-point score was designed to create a common language in the evaluation of stroke patients by correlating exam findings with a scoring system. This score ha...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Patient Care Columns Source Type: news