Prehospital use of transcranial ultrasound to diagnose strokes is feasible, according to this paper. The study required stroke neurologists to rendezvous with paramedics on possible stroke calls and perform a physical exam and a transcranial ultrasound. The authors found a sensitivity of 78% and specificity of 98% diagnosing 73 strokes and 29 stroke mimics out of […]

We focus a lot on acute stroke patients. Rapid response. Rapid assessment. Rapid transport. Dispatch, Delivery, Door, and Drug. But what about the other D’s associated with stroke such as Discharge? And Disability? And Depression? Stroke is the chief culprit of serious long term disability in the US. Below is the Modified Rankin Scale (MRS), a […]

Heart Attacks have the benefit of the EKG. A quick test. An expert read. A diagnosis (or close). On top of the EKG blood tests will be ordered. In stroke, there’s no luxury of an easy diagnostic test. The CT won’t necessarily show evidence of an early acute infarct; It’s role is to rule out […]

The 3AM call for a vital signs check is always a frustrating one. We’ve all been there, half-asleep, exhausted, wrinkled uniform. The patient’s blood pressure is high, as usual, and it has been for years. They are non-compliant with medication. Your options now are to transport or secure patient refusal (or perhaps better for those in […]

Published in JAMA last month the Prehospital Acute Neurological Treatment and Optimization of Medical care in Stroke Study (PHANTOM-S; conducted in Berlin, Germany) studied 6182 patients randomized to 1) receiving the standard prehospital care (stroke alert and rapid transport only) versus 2) receiving care via a STEMO (Stroke Emergency Mobile). Let’s skip to the results: […]

In this study out of UCSF, patients were surveyed as to see if they would prefer treatment with fibrinolytic (TPA) therapy in the event of a stroke. Adults over 50 years of age read a scenario where they suffered a stroke and were brought to the emergency department by paramedics. The risks and benefits of TPA therapy […]

A 52 yof complains of chest and epigastric pain. Here is her 12 lead ECG: Image credit| Click here for larger image 50 minutes later she developed left-sided hemiplegia, facial asymmetry, deviated gaze, and left-sided neglect. (Which stroke syndrome is this indicative of?) A CT scan revealed a blockage in the R-MCA. The CT scan also indicated that the right insular cortex […]

Recall from part 1 where we discussed how common it was to observe 12 lead ECG changes in stroke patients. Now let’s look at regions deep inside your head thought to be responsible. In each hemisphere of the brain there’s a part of the cerebral cortex which folds over on itself. It’s called theinsular cortex and it […]

Which image below is the biggest attention-getter? -OR- The Italian sports car vs. motorcycle collision or the middle-aged mother of two whose daughter noticed her crooked smile at dinner? How many ‘trauma junkies’ ride our ambulances and staff our Emergency Departments? Which motivated you to become an EMS/emergency medicine provider: facial droop or rollovers with […]

15-30% of strokes are cardioembolic and 60-90% of stroke patients present with ECG abnormalities. (Source) So let me ask you some questions. Is it important to obtain a 12 lead ECG during a suspected acute stroke in the prehospital setting? Why? Why not? Does it really matter either way? Before we discuss the answer… Here’s the abnormalities you’re likely to […]