Stroke, which is a disease that affects the arteries leading to and within the brain, is the number 5 leading cause of death in the United States. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain ruptures or is blocked by a blood clot.
A stroke is a medical emergency, and EMS providers are usually the first responders when someone suffers a stroke outside of the hospital. EMTs and paramedics should know the symptom of stroke, how to assess a patient for a stroke, and how to alert emergency room (ER) personnel regarding the admission of a patient with stroke.
Common Stroke Symptoms
A clot or rupture can happen anywhere in the brain, or in the arteries leading to the brain. There are three main types of stroke: ischemic stroke, caused by a blockage in an artery; hemorrhagic stroke, caused by a rupture in a blood vessel; and transient ischemic attack (TIA), which can be temporary, but causes stroke-like symptoms and is a medical emergency.
- Right hemispheric stroke presents with slurred speech, and weakness or numbness on the left side of the body.
- Left hemispheric stroke presents with speech difficulties (not able to find the right word, inability to speak), comprehension difficulties, and weakness on the right side of the body.
- Symptoms of a brain stem stroke include nausea, vomiting, or vertigo; speech difficulties; problem swallowing; abnormal eye movements; and possibly decreased consciousness
- Intraparenchymal hemorrhage presents with nausea and vomiting, one-sided weakness, headache, and decreased consciousness
- Subarachnoid hemorrhage symptoms are neck stiffness or pain; “worst headache of life;” intolerance to light
Some conditions that can mimic stroke symptoms are intoxication, drug overdose, Bell’s Palsy, brain tumors, and hypoglycemia
Field Assessment of Stroke
Prehospital stroke assessment education increases the accuracy of stroke assessment. This, in turn, helps EMS quickly identify stroke and transport the individual to the appropriate center. Although no official standards have been released by the American Stroke Association (ASA), most assessment tools have similar guidelines:
- Facial droop:
- Normal: Left and right side of the face move together and equally
- Abnormal: Face appears frozen, doesn’t move, shows significant droop on one side
- Arm Drift:
- Normal: Left and right arms move together, or not at all
- Abnormal: One arm doesn’t move with the other
- Normal: Patient uses correct words, no slurring or confusion
- Abnormal: Slurred speech, incorrect words or language, or cannot speak at all
If a patient is assessed to have suffered a stroke, EMS professionals can notify hospital staff when they are in route. Pre-notification improves rapid triage, evaluation, and treatment of patients with acute ischemic stroke. The sooner patients get appropriate medical treatment, the greater the chances for a better outcome.
For an overview of stroke, check out the Understanding Stroke poster from Pocket Nurse, perfect for a classroom or sim lab.