17846 - Stroke Guidance

  1. Would it be possible to view your stroke diagnosis and treatment guidance?
  2. Do you have any guidance on the identification of posterior/cerebellar stroke? 

 

  • Reference:
    17846
  • Response:
    1. Would it be possible to view your stroke diagnosis and treatment guidance?
    2. Do you have any guidance on the identification of posterior/cerebellar stroke? 

    EEAST has Stroke guidance in our Clinical Manual, which also refers to the AACE Clinical Practice Guidelines 2013 page 174. Our stroke guidance in the manual includes:

    FAST Test – Facial weakness: can the person smile or show their teeth symmetrically? Has their mouth or eyelid drooped? Look for NEW lack of symmetry
    Arm weakness: Can the person raise both arms together? Hold 5 seconds/ does one arm drift downwards?
    Speech Problems: Can the person speak clearly and understand what you say
    Time: If FAST positive, rapidly assess for thrombolysis/blue light pre-alert criteria; patient should be extricated to ambulance as soon as possible and further assessment carried out en route to hospital
     
    Acute Stroke: Thrombolysis
    When attending suspected strokes, as clinicians we must assess to see if the patient would benefit from being rapidly assessed for thrombolysis on arrival at A&E. There are many contraindications for stroke thrombolysis, most of which can only be determined in hospital.

    Stroke Pathway:

    • Positive FAST assessment or persistent focal neurological deficit suggestive of stroke?
    • Can you exclude hypoglycaemia?
    • Can you rule out a major ABC problem?

      No to any of the above – Further assessment required- convey to nearest A&E department

      Yes to all of the above:
      • Is there a clear time of onset of stroke symptoms? NO – Convey to nearest A&E Department. YES – Establish nearest hospital offering stroke thrombolysis service – Can the patient be in this hospital within 4.5 hours from onset of symptoms
      • YES – Take to nearest hyer-acute hospital providing stroke thrombolysis – Pre-alert/discuss with stroke team in line with local guidance. Convey rapidly if eligible for fast track specialist assessment/thrombolysis. ECG Monitoring and full observations en route. Administer oxygen only when SPO02 below 95%. Convey patient with a relative or carer.
    • Always consider calling clinical advice/EOC clinical co-ordinator line if required for advice on stroke pathway and thrombolysis available.

    EEAST do not have specific guidance on posterior circulation strokes. The Trust are not using any tools other FAST +ve but our clinicians are trained to do neuro/cranial nerve assessment

        3.     Are there any tools you advocate in the diagnosis of vertigo and ataxia?

    EEAST are currently undertaking a small service improvement audit using ROSIER (Recognition of Stroke in the Emergency Room) scale. There are other proposals regarding AVVV (Ataxia, Vomiting, Vertigo, Visual deficits), however at the moment these are in their early planning and idea stages.

  • Area:
    Trust wide
  • Category:
    • Emergency Operations
    • Training
  • Month:
  • Year: