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Neurological Responsoft EMS Protocols Neurological Page 37 Neurological 10/13/2020 Neurological CVA/Unconscious Neurological Stroke can present with dysrhythmias, aphasia, vertigo, dizziness, headaches, weakness, paralysis, Head trauma, and tumors. There are 3 types of CVA, (Hemorrhagic, t...

Neurological Responsoft EMS Protocols Neurological Page 37 Neurological 10/13/2020 Neurological CVA/Unconscious Neurological Stroke can present with dysrhythmias, aphasia, vertigo, dizziness, headaches, weakness, paralysis, Head trauma, and tumors. There are 3 types of CVA, (Hemorrhagic, thrombosis, and embolus) Assess for time of onset and progression of symptoms. Hypertension can also be present with CVA. Universal Patient Assessment Spinal Injury Assessment (If necessary) Cardiac Monitor IV/IO IV/IO Blood Glucose Examine patient closely for signs of trauma In patients with decreased level of consciousness of unknown etiology Glucose < 60 mg/dl Glucose > 60 mg/dl Naloxone 0.4 - 2 mg IVP, IO, IN May repeat 5 to 10 minutes if partial response is noted Dextrose 10% 100 ml boluses until patient awake &/or follow up blood sugar > 60 mg/dl if unable to obtain IV Glucagon Prehospital Stroke Screen Obtain medical history and medications if possible. Any use of anti-coagulants is important. Hyperventilate patient to achieve an end-tidal CO2 reading of 35 mmHg if vital signs are deteriorating or if there are signs of impending herniation as evidenced by unilateral dilated pupil, sudden change in level of consciousness, decorticate or decerebrate posturing LAMS Score ALL patients with positive stroke screen, should be transported emergently. Attempt to bring primary historian to hospital with patient. Consider other protocols as indicated 1 mg IM, IN Important Points to Consider 1. When was patient last normal? This may take some detective work when talking with family or witnesses. 2. Is the patient on anticoagulants? 3. If intubation is required, hyperventilate as necessary to attain end-tidal CO2 of 35 mmHg. Avoid going below 35. 4. Patients with LAMS of 1-3 should go to closest stroke center. LAMS of 4-5 should go to closest interventional stroke center. Seizure Go to: CVA/Unconscious-continued Responsoft EMS Protocols Page 38 10/13/2020 Neurological CVA/Unconscious-continued Neurological Stroke Screen Evaluate the patient using the Los Angles Motor Scale (LAMS) EMS stroke triage tool below: History Last time patient without neurological symptoms Date: Time: LA Motor Scale Facial Droop Absent = 0 Present = 1 Arm Drift Absent = 0 Drift = 1 Falls Rapidly = 2 Grip Strength Absent = 0 Weak = 1 No Grip = 2 Total Yes No Stroke Scale Deficits? Age > 18 years of age? Symptom duration 5 hours? Blood Glucose 60 - 400 mg/dl? Head Trauma Ruled Out? If “yes” to all five questions above, then pre-hospital screening criteria is met. Declare “Stroke Alert” and follow appropriate treatment and transportation steps. Patients with LAMS Scores of 1 - 3 points should be transported to the closest hospital as listed below: •Grant Medical Center •OSU East Hospital •Mt. Carmel East Hospital •OSU Wexner Medical Center •Mt. Carmel West Hospital •Riverside Methodist Hospital •Mt. Carmel St. Ann’s Hospital Patients with LAMS of 4 - 5 points should be transported to the closest Comprehensive Stroke Center unless bypassing a primary stroke center results in an incremental increase in transportation time greater than 15 minutes. Comprehensive stroke centers are: •Mt. Carmel East Hospital •OSU Wexner Medical Center •Riverside Methodist Hospital Responsoft EMS Protocols Page 39 10/13/2020 Seizure Neurological Some causes of seizures are: Head injury, overdose, stroke, hypoxia, infection, hypoglycemia, hyperglycemia, brain tumor, eclampsia, alcohol. Neurological Universal Patient Assessment Spinal Injury Assessment If patient is having active seizure on EMS arrival Midazolam (Versed) (Versed) Midazolam MAD (Preferred) IN dose see: MAD Transport all patients experiencing first time seizure activity. Transport patients with known seizure disorders if seizure different than normal or continues longer than 3 - 5 minutes. Cardiac Monitor Place in Rescue position (patient’s side) 10 mg IN (5 mg per nostril) Blood Glucose Glucose < 60 mg/dl Dextrose 10% 100 ml boluses until patient awake &/or follow up blood sugar > 60 mg/dl if unable to obtain IV Glucagon 1 mg IM, IN Status epilepticus Postictal Any patient with seizure activity upon arrival of EMS should be intubated if appropriate Adult AdultAirway Airway Protocol Focused history / Physical exam IV/IO IV/IO IV/IO Blood Glucose > 60 mg/dl Status / Seizure recurs? Status / Seizure recurs? Midazolam (Versed) Midazolam (Versed) (Preferred) IN dose see: MAD (Preferred) IN dose see: MAD 10 mg IN (5 mg per nostril) 10 mg IN (5 mg per nostril) 5 mg IVP, IO 2 mg IVP, IO May repeat IVP, IO every 5 minutes x 2 May repeat IVP, IO every 5 minutes x 2 IN is preferred unless IV/IO access has already been obtained. If IV/IO in place then preferred route is IV/IO. IN is preferred unless IV/IO access has already been obtained. If IV/IO in place then preferred route is IV/IO. Responsoft EMS Protocols Page 40 10/13/2020