Stroke Assessment

The term “Stroke” refers to any form of cerebral-vascular event that reduces blood flow to the brain, either through cerebrovascular haemorrhage causing and increase in intracranial pressure (ICP),w hich results in a decrease in cerebral perfusion, or cerebrovascular ischaemia, in which a blood clot or thrombus in the cerebral arteries causes a blockage, which results in poor perfusion distal to the blockage within the brain. The term “Stroke” used to refer to TIA and CVAs (Trasient Ischeamic Attacks – or mini strokes and Cerebral Vascular Attacks – big strokes); however, in Australia and most countries globally, the term has been simplified to just “Stroke.”

A Stroke or Stroke like symptoms in patients is a very common job for paramedics to attend to and early recognition and treatment at a definitive care institute, such as a hospital with the ability to perform a Computer Tomographic (CT) sccan and Neuro-surgical capabilities is paramount to the expected survival and longterm rehabilitational abilities of these patients.

In Australia, the FAST assessment has been adopted as an excellent tool in assessing a patient for the potential of having a stroke; however, it is recognised that many other methods are available and utilised globally.

The FAST assessment includes:

Face – looking at the person’s face for signs of symmetry or assymetry. You can ask the patient to smile, which will identify the symmetry or lack of symmetry in the patient’s facial muscles.

Arms – assess the strength of both the motor and sensory response in the patients arms and legs. Sometimes a patient who has had a stroke will only have movement on one side of their body. This is why it is so important to assess all four limbs for normal or abnormal motor or sensory responses.

Speech – assess the patient’s speech. Is it slurred? Does it sound like the patient is intoxicated? Is this normal – ask someone who knows the patient if this is how he or she normally speaks?

Time – time of onset of these symptoms should be assessed. Time to definitive treatment is the greatest predictor of longterm outcome and rehabiliation outcomes.

Other concepts which should be considered and assessed by a Paramedic attending a suspected stroke victim includes:

Assessing a person’s GCS

Assessing a person’s Vital Signs – high blood pressure may be indicative of a potential cause of the stroke.

Assessing the person’s Pupils for size, reactivity, equalness or un-equality.

Assessing the person’s blood glucose levels (BGLs/BSLs), because this may be another cause of very similar manifestations of a stroke.

Obtain an accurate previous medical history and current history of the events leading up to this situation.

Identify if there was any chance the patient has taken any drugs or alcohol (legal or ilicit).

And finally, make sure to transport these people urgently to hospital.