Step-by-step: CVA

Cerebrovascular Accident (Stroke):

1. Upon arrival to scene perform EMCAP, with special attention to any indications on scene that might indicate threats, or potential causes of patient presentation.

2. Form a general impression of the patient, noting LOA, position, respiratory effort, and skin colour and condition.

3. Perform the primary survey, assessing airway patency, respiratory rate and work of breathing, and pulse for rate, rhythm, and strength, as well as cap refill. Make corrections to life threats before moving on with assessment.

4. Obtain HPI, PMHx, Medications, Allergies, and las ins/outs.

5. Obtain baseline vitals including BGL as hypoglycemia can mimic a CVA.

6. Perform physical assessment including FAST stroke exam, and noting LAMS score to screen for large vessel occlusion.

7. If the stroke screen is positive, contact stroke centre and initiate stroke bypass protocol, provided the patient meets criteria.

8. Initiate transport and, if authorized, obtain IV access.

9. Be prepared for potential complications including: Combativeness, decreased LOA, Airway compromise, seizures, and increased ICP. Signs of rising ICP include:

• Fixed, unequal, or unresponsive pupils.

• Unilateral motor response.

• Posturing.

• Cushing's Triad.

Treat elevated ICP by maintaining ETCO2 30-35mmHg if possible.