apid rterial o clusion xam RACE - AmericanCME...symptoms of stroke, and improve stroke recognition...

ContactAmericanCMEbyemailatAmericanCME@AmericanCME.comwithanyquestionsregardingthecontentsoftheRACESupplementalSkillGuide.

RapidArterialoCclusionExam

RACESupplementalSkillGuide

Purpose:TheAmericanCMERACESupplementalSkillGuidehasbeenproducedtoenhancetheEMSprovider’sabilitytorecognizeLVOstrokesbypracticingthenecessaryhandsonskillsassociatedwiththeRapidArterialoCclusionExam(RACE)strokeseverityscale.ThisdocumenthasbeenproducedasasupplementtotheAmericanCMEEMSvideo-basedcontinuingeducationcourse,“Stroke:ANewStandardofCareforLargeVesselOcclusion(LVO)”.Visitwww.AmericanCME.comtocreateanaccountandcompletethisvideo-basedEMSCE.Itisrecommendedtocompletetheonlinecoursepriortoutilizingthisguidetounderstandthescienceandthenecessarybackgroundinformation.Thisguideprovidesstep-by-stepinstructionsthatanyEMSproviderorEMSinstructormayuseforEMStrainingandeducation.Inaddition,multiplescenariosareincludedtoaidinlearningcomprehension.PleasenotethatthisguideisnotpreapprovedforEMScontinuingeducationcreditsbyanyStateagency.AmericanCMEencouragesanyEMSagencyorjurisdictiontoutilizethisguideastheyseefit.

TableofContents

SAMPLEEMSCONTINUINGEDUCATIONLESSONPLAN..................1-2

INTRODUCTION................................................................................3

LARGEVESSELOCCLUSION(LVO)STROKES........................................3

RAPIDARTERIALOCCLUSIONEXAM(RACE).......................................4

PERFORMINGRACE........................................................................5-6

SAMPLERACEFORM.........................................................................7

EMSTRANSPORTOPTIONS................................................................8

RACESCENARIOS.........................................................................9-18

WORKSCITED................................................................................19

SampleEMSContinuingEducationLessonPlan

NOTE:EMSagenciesshouldmodifythissamplelessonplantomeettheirlocalorStateEMSeducationstandards,asneeded.Title:IdentifyingLVOStrokeswithRACECreditCategory:PatientAssessmentTopic:IdentifyingLargeVesselOcclusion(LVO)StrokesusingtheRapidArterialoCclusionEvaluation(RACE)Presenter:TBDCourseDescription:RecognitionofLVOinthefieldandtriagetotheclosestappropriatestrokecenterisacriticalskillforEMSproviders.ThisCEsessionisdesignedtoallowstudentstodeveloppsychomotorcompetencyperformingRapidArterialoCclusionEvaluation,orRACE,throughscenario-basedtraining.Students(EMSproviders)willperformapatientassessmentonasimulatedpatient,quantifystrokeseverityusingRACE,andindicatetheclosestappropriatestrokecentertotransportthepatient.Competencywillbegainedthroughrepetitionandguidancefromtheinstructors.ThispracticalisdesignedtogiveEMSprofessionalstheconfidencetoperformacompletestrokeassessmentutilizingRACEinthefieldandmakequalityemergencytransportdecisionsbasedonthecapabilitiesandlimitationsofvariousstrokecenters.EMSContinuingEducationCredits:

MFR/EMR:1Hour EMT:1Hour AEMT:1HourParamedic:1Hour

CourseObjectives:● Defineanddescribelargevesselocclusion(LVO)stroke. ● DefineanddescribetheRapidArterialoCclusionExam(RACE)andhowitidentifiesstrokeseverity. ● PerformapatientassessmentonasimulatedpatientandincludetheperformanceofRACE. ● IdentifytheclosestappropriatestrokecenterforthesimulatedpatientbasedontheRACEscore,aswell

asotherassessmentfindings. NOTE:AmericanCMEhasdevelopedthisCElessonplanandoutlinetobeusedormodifiedbyanyEMSproviderorinstructorfortheirspecificeducationalandtrainingneeds.Thislessonplancanbemodifiedtosuittheneedsofaninstructor'sagencyorgoverningbody.ItistheresponsibilityofanyinstructorthatutilizesthisinformationtogainapprovalfromtheirlocaljurisdictionorstatethatapprovesEMSCE.

SampleCELessonPlanOutline

NOTE:EMSagenciesshouldmodifythissamplelessonplanoutlinetomeettheirlocalorStateEMSeducationstandards,asneeded.

1. Introductiona. StudentwillbegivenanoverviewofthisCEandinformedoftheexpectations.

2. LargeVesselOcclusion(LVO)Strokesa. Defineanddescribelargevesselocclusion(LVO)stroke.

3. RapidArterialoCclusionExam(RACE)a. DefineanddescribetheRapidArterialoCclusionExam(RACE)andhowitidentifiesstrokeseverity.

4. PerformingRACE:

a. List,describeanddemonstratethecomponentsofRACE.

5. EMSTransportOptionsa. IdentifytheclosestappropriatestrokecenterforthesimulatedpatientbasedontheRACEscore,aswellas

otherassessmentfindings.

6. RACEScenariosa. PerformacompletepatientassessmentonasimulatedpatientandincludetheperformanceofRACE.

b. Students(EMSproviders)will:

i. Performanassessmenton5separatesimulatedpatientsii. IdentifytheseverityofastrokeusingRACEiii. Indicatetheclosestappropriatestrokecentertotransportthepatientiv. Performasimulated“AcuteStrokeAlert”,whichcommunicatesthekeycriteriathatshouldbe

relayedtothereceivinghospital.

c. Scenario1-5i. Studentsareprovideddispatchinformationii. Studentsareprovidedasimulatedpatientthatmatchesdispatchinformationiii. Studentsperformacompletepatientassessment

1. Obtainnecessaryhistoryandvitalsigns2. PerformRACE3. Triagethepatienttoanappropriatedestination4. Providean“AcuteStrokeAlert”tothereceivingfacility

iv. Theinstructorwillobservethestudentsforstrengthsandareasthatcoulduseimprovement.Theseobservationswillbeusedtofacilitateabriefconversationbetweeneachscenario.

NOTE:AmericanCMEhasdevelopedthisCElessonplanandoutlinetobeusedormodifiedbyanyEMSproviderorinstructorfortheirspecificeducationalandtrainingneeds.Thislessonplancanbemodifiedtosuittheneedsofaninstructor'sagencyorgoverningbody.ItistheresponsibilityofanyinstructorthatutilizesthisinformationtogainapprovalfromtheirlocaljurisdictionorstatethatapprovesEMSCE.

1. Introduction

a. StudentwillbegivenanoverviewofthisCEandinformedoftheexpectations.RecognitionofLVOinthefieldandtriagetotheclosestappropriatestrokecenterisacriticalskillforEMSproviders.ThisCEsessionisdesignedtoallowstudentstodeveloppsychomotorcompetencyperformingRapidArterialoCclusionEvaluation,orRACE,throughscenario-basedtraining.Students(EMSproviders)performapatientassessmentonasimulatedpatient,identifytheseverityofastrokeusingRACE,andindicatetheclosestappropriatestrokecentertotransportthepatient.Competencywillbegainedthroughrepetitionandguidancefromtheinstructors.ThispracticalisdesignedtogiveEMSprofessionalstheconfidencetoperformacompletestrokeassessmentutilizingRACEinthefieldandmakequalityemergencytransportdecisionsbasedonthecapabilitiesandlimitationsofvariousstrokecenters.

2. LargeVesselOcclusion(LVO)Strokes:

a. Defineanddescribelargevesselocclusion(LVO)stroke.

Allstrokesarenotequal.Justasstrokescanpresentwithdifferentsetsofsignsandsymptoms,dependingonwhatpartofthebrainisaffected,theycanalsovaryinseveritydependingonthesizeofthebloodvesselaffected.Alargevesselocclusion,orLVO,isakindofischemicstrokethataffectsanyoftheproximalbloodvesselsofthebrain,including;theinternalcarotidarteries,themiddlecerebralarteries,thebasilarartery,andtheanteriorcerebralarteries.TheobstructionofcerebralbloodflowinthepresenceofaLVOismoresevereduetotheinvolvementofthelargecerebralarteries.Greaterdeclinesincerebralbloodflowcorrelatewithmoreextensiveregionsofischemiaandincreasedbraintissuedeath.Infact,oneprospectivestudyshowedthepresenceofanLVOwasassociatedwitha5-foldincreaseindeath,anda3-folddecreaseingoodoutcomes(1).EvenmorealarmingistheprevalenceofLVOstrokes.StudieshaveshownthatnearlyhalfofallischemicstrokesareLVOs.(1)NotonlyarethestakesmuchhigherforstrokepatientswithLVOs,butstandardthrombolytictreatmentistypicallyineffective.ThelikelihoodoftPAclearingaclotdecreasesasthesizeoftheclotincreases.Asaresult,thesepatientsrequireearlyidentificationinthefieldandpriority1transporttoaninterventionalstrokecentercapableofmechanicalthrombectomywithastentretriever.Remember,timeisbrain.Merelyidentifyingthatastrokeisoccurringinthefieldisnolongergoodenough,EMSprovidersmustnowtriagestrokepatientstoanappropriatestrokecenterthatcanprovidernecessaryinterventions.

3. RapidArterialoCclusionExam(RACE):

a. DefineanddescribetheRapidArterialoCclusionExam(RACE)andhowitidentifiesstrokeseverity.

TheroleoftheEMSproviderisnolongerlimitedtojustidentifyingstrokepatientsinthefield.NowEMSmustquantifystrokeseverityinordertoidentifythemostseverecasesofischemicstrokeandensurethatthesepatientsaretakentoaninterventionalstrokecentercapableofmechanicalthrombectomywithastentretriever.LVOstrokesarethemostsevereformofischemicstroke,andrecognizingtheminthefieldisessentialtoachievingfunctionalindependenceforstrokepatients.tPAalonehasproventobeanunreliableandineffectivetreatmentforLVOs.Themostpopularvalidatedstrokescalesofrecognitiondesignedforprehospitaluseinclude:theCincinnatiPrehospitalStrokeScale(CPSS)andtheLosAngelesPrehospitalStrokeScreen(LAPPS).Eachofthesestrokescaleswerecreatedinthe1990sfromelementsoftheNIHstrokescaletoidentifythevarioussignsandsymptomsofstroke,andimprovestrokerecognitioninthefield.Basically,thesestrokescalesidentifythatastrokehasoccurred,buttheydon’tidentifytheseverityofastroke.Inaddition,theydonotpredictifthestrokeisanLVO.Asstroketreatmenthasevolvedoverthelast20years,theneedforfieldrecognitionofLVOshasarisen.ThenewfoundabilitytosuccessfullytreatLVOsusingmechanicalthrombectomywithastentretrieverhasestablishedtheneedforEMSproviderstotriagethesepatientstointerventionalstrokecenters.ThenextgenerationofstrokescalesdesignedforLVOrecognitioninthefieldistheRACEscale,whichisdrawingagreatdealofattentionduetoitsabilitytodetectLVOswithahighdegreeofaccuracy.RACEstandsforRapidArterialoCclusionExam.Likeotherscalesofrecognition,itisalsoderivedfromtheNIHstrokescaleandwasdesignedspecificallyforEMSproviderstodetectLVOsintheprehospitalsetting.RACEscoresapatient’sstrokebasedontheextentandseverityoftheirdeficits.Theoverallscorerangesfrom0to9.0meaningnodeficitswerepresent.Anyscoregreaterthan0meansthatastrokehasoccurred.LVOsarelikelywhenastrokepatienthasaRACEscoreofgreaterthanorequalto5(2).

4. PerformingRACE:

a. List,describeanddemonstratethecomponentsofRACE.TheRACEscaleexamines5categories:

1. Facialpalsy2. Armmotorfunction3. Legmotorfunction4. Head&eyedeviation5. Aphasia(ifright-sideddeficitsareidentified)ORagnosia(ifleft-sideddeficitsareidentified)

Eachcategoryisscoredbasedonthepatient’sdegreeofdisability;0meaningnodeficit,1meaningamildtomoderatedeficit,and2meaningaseveredeficitispresent.TocompleteaRACEexam,conducttheassessmentsbelow:

FacialPalsy

● HOWTOASSESS:Askthepatienttoshowyoutheirteethorsmile. ● SCORINGCRITERIA:

NODEFICIT=0(faceissymmetrical)MILD=1(slightlyasymmetrical)MODERATETOSEVERE=2(completelyasymmetrical)

ArmMotorFunction

● HOWTOASSESS:Askthepatienttoclosetheireyesandextendtheirarmsat90degreesandholdthemforacountoftenwiththeirpalmsup.Theirarmanglecanbemodifiedto45degreesifthepatientissupine.

● SCORINGCRITERIA: NODEFICIT=0(abletoraisearmandholdfor10seconds)MODERATE=1(abletoraisearm,butunabletoholdfor10seconds)SEVERE=2(unabletoliftanarm)

LegMotorFunction

● HOWTOASSESS:Askthepatienttoraiseonelegatatimetoa30-degreeangleandholditupfor5seconds.

● SCORINGCRITERIA: NODEFICIT=0(abletoraiselegandholdfor5seconds)MODERATE=1(abletoraiseleg,butunabletoholdfor5seconds)SEVERE=2(unabletoraisealeg)

HeadandGazeDeviationNoteifthepatient’sheadoreyesaredeviatedtooneside.Inthepresenceofseverestrokesthepatient’sheadwilloftenbeturnedtowardsthesideofthestrokeandthepatient’seyesmayalsobeturnedtowardthatside.

● HOWTOASSESS:Ifpatient’sheadoreyesaretowardsoneside,askthemtolooktowardstheotherside. ● SCORINGCRITERIA:

○ NODEFICIT=0(noheadorgazedeviation) ○ GAZEPRESENT=1(unabletoshiftgazepastmidline)

Aftercompletingtheassessmentsoffacialpalsy,armmotorfunction,legmotorfunctionandheadandgazedeviation,performoneofthefinaltwocategoriesbasedonearlierassessmentfindings:

● Right-sideddeficits=AssessforAphasia ● Left-sideddeficits=AssessforAgnosia

Aphasia(forpatientspresentingwithright-sideddeficits)Ifright-sideddeficitswereobservedcheckforaphasia.Aphasiaisthelossofabilitytounderstandorexpressspeech.Right-sideddeficitsresultfromthelefthemisphereofthebrainbeingaffectedbyastroke.Theleftcerebralhemispherecontainstheregionofthebrainresponsibleforcomprehendinglanguage.

● HOWTOASSESS:Ifright-sideddeficitsarefound,askthepatienttodothefollowing:1-Closeyoureyes.2-Makeafist.

● SCORINGCRITERIA: NODEFICIT=0(performsbothtaskscorrectly)MODERATE=1(performsonetaskcorrectly)SEVERE=2(performsneithertask)

Agnosia(forpatientspresentingwithleft-sideddeficits)

Ifleft-sideddeficitswereobservedcheckforagnosia.Ifthepatientpresentswithleft-sideddeficitsthatmeanstherighthemisphereofthebrainisbeingaffectedbythestroke.Therightcerebralhemispherecontainstheregionofthebrainresponsibleforinterpretingsensationsandrecognizingthings.Agnosiaistheinabilitytointerpretsensations,or“recognizethings,”typicallyasaresultofbraindamage.Basically,agnosiaistheinabilitytoprocesssensoryinformation.Thiscanresultinthepatientfailingtorecognizetheirleftarm,orthefactthatamotordeficitispresentintheirleftarm.Remember,youasanEMSproviderknowthattheyhaveleft-sideddeficits,whichiswhyyou’reassessingagnosiaatthispoint.Essentially,thispartoftheassessmentistoidentifyifthepatientrecognizestheirleftarm,andiftheyrecognizetheweaknessintheirleftarm.

● HOWTOASSESS:Ifleft-sideddeficitsarefound,askthepatientthefollowing:1-“Whosearmisthis”,whileshowingthemtheirleftarm.2-“Canyoumoveyourarm?”

● SCORINGCRITERIA: NODEFICIT=0(recognizesleftarmandacknowledgesleftarmweakness)MODERATE=1(doesnotrecognizeleftarmORdoesnotacknowledgeleftarmweakness)SEVERE=2(doesnotrecognizeleftarmANDdoesnotacknowledgeleftarmweakness)

SampleRACEForm:This1pageformwillassistEMSinutilizingRACEmoreeffectivelyintheprehospitalsetting.ThisresourcewillactasareferencetoolforthisnewandeffectivemeansofidentifyingLVOsintheprehospitalsetting.

RapidoCclusionArterialExam(RACE)Form

FACIALPALSYAskthepatienttoshowyoutheirteethorsmile.

● NODEFICIT=0(faceissymmetrical) ● MILD=1(slightlyasymmetrical) ● MODERATETOSEVERE=2(completelyasymmetrical)

ARMMOTORFUNCTIONAskthepatienttoclosetheireyesandextendtheirarmsat90degreesandholdthemforacountoftenwiththeirpalmsup.Theirarmanglecanbemodifiedto45degreesifthepatientissupine.

● NODEFICIT=0(abletoraisearmandholdfor10seconds) ● MODERATE=1(abletoraisearm,butunabletoholdfor10seconds) ● SEVERE=2(unabletoliftanarm)

LEGMOTORFUNCTIONAskthepatienttoraiseonelegatatimeuptoa30-degreeangleandholditupfor5seconds.

● NODEFICIT=0(abletoraiselegandholdfor5seconds) ● MODERATE=1(abletoraiseleg,butunabletoholdfor5seconds) ● SEVERE=2(unabletoraisealeg)

HEADANDGAZEDEVIATIONIfpatient’sheadoreyesaretowardsoneside,askthemtolooktowardstheotherside.

● NODEFICIT=0(noheadorgazedeviation) ● GAZEPRESENT=1(unabletoshiftgazepastmidline)

APHASIA(Inabilitytounderstandorexpressspeech)Ifright-sideddeficitsarefound,askthepatienttodothefollowing:1)Closeyoureyes.2)Makeafist.

● NODEFICIT=0(performsbothtaskscorrectly) ● MODERATE=1(performsonetaskcorrectly) ● SEVERE=2(performsneithertask)

AGNOSIA(Inabilitytoprocesssensoryinformation)Ifleft-sideddeficitsarefound,askthepatientthefollowing:1-“Whosearmisthis”,whileshowingthemtheirleftarm.2-“Canyoumoveyourarm?”

● NODEFICIT=0(recognizesleftarmandacknowledgesleftarmweakness) ● MODERATE=1(doesnotrecognizeleftarmORdoesnotacknowledgeleftarmweakness) ● SEVERE=2(doesnotrecognizeleftarmANDdoesnotacknowledgeleftarmweakness)

TOTALSCORE

TransportanypatientwithaRACEscore>5totheclosestComprehensiveStrokeCenterorinterventionalstrokecentercapableofmechanicalthrombectomywithastentretriever,ifprotocolsallow.

5. EMSTransportOptions:

a. IdentifytheclosestappropriatestrokecenterforthesimulatedpatientbasedontheRACEscore,aswellasotherassessmentfindings.Remember,ifthepatienthasaRACEscoreof5orgreaterthereisahighprobabilityofalargevesselocclusion(LVO)(2).ThepatientshouldbetransportedtotheclosestComprehensiveStrokeCenter,oraPrimaryStrokeCentercapableofperforminginterventionalstroketreatmentssuchasmechanicalthrombectomy,whenavailableandifprotocolsallow.

6. RACEScenarios:

Outlinea. PerformapatientassessmentonasimulatedpatientandincludetheperformanceofRACE.

b. Students(EMSproviders)will:

i. Performanassessmenton5separatesimulatedpatientsii. IdentifytheseverityofastrokeusingRACEiii. Indicatetheclosestappropriatestrokecentertotransportthepatient

c. Scenario1–5:

i. Studentsareprovideddispatchinformationii. Studentsareprovidedasimulatedpatientthatmatchesdispatchinformationiii. Studentsperformapatientassessment

1. PerformRACE2. Triagethepatienttoanappropriatedestination

iv. Theinstructorwillobservethestudentsforstrengthsandareasthatcoulduseimprovement.Theseobservationswillbeusedtofacilitateabriefconversationbetweeneachscenario.

Scenario#1:Dispatch:Dispatchedtoapatientwithone-sidedweakness.ArrivetoFind:A55year-oldmalepatientsittinginhislivingroom.Thepatient’sfamilystatesthepatientwasfoundinthisconditionaftertheyreturnedhomefromshopping.Thepatienthasobviousright-sidedweaknessanddifficultyspeaking.RACEStrokeScale:RACEscoreof5.SeetheRaceGuidethathasbeencompletedforScenario#1.StudentsshouldarriveatthesamescorewhencompletingtheirownRaceGuide.Symptomsdemonstratedbysimulatedpatient:

● FacialPalsy:Scoreof1.Slightlyasymmetrical. ● Armmotorfunction:Scoreof2.Unabletoliftrightarm. ● Legmotorfunction:Scoreof1.Abletoraiserightlegbutunabletoholdfor5seconds. ● Headand/oreyegazedeviation:Scoreof1.Present;unabletoshiftgazepastmidline. ● AssessforAphasia:Scoreof0.Nodeficitpatientisabletoperformbothtaskscorrectly. ● AssessforAgnosia:Notassessed.(Onlyassessedforleft-sideddeficits)

TriageDecision:ThepatientispresentingwithsignsofaLVOasdemonstratedbyaRACEscoreof5.ThispatientshouldbetriagedandrapidlytransportedtotheclosestComprehensiveStrokeCenterorinterventionalstrokecentercapableofmechanicalthrombectomywithastentretriever.TransportanypatientwithaRACEscore>5totheclosestComprehensiveStrokeCenterorinterventionalstrokecentercapableofmechanicalthrombectomywithastentretriever,ifprotocolsallow.

RACEScenario#1:ThecompletedRACEform.

SCORE1

SCORE2

SCORE1

SCORE0

TOTALSCORE 5

Scenario#2:Dispatch:Dispatchedtoapatientwithslurredspeech.ArrivetoFind:A70year-oldmalepatientalertandorientedtimes4sittingathiskitchentable.Thepatient’swifestatesshecamehomefrombookclubandnoticedherhusband’sspeechwasslurred.RACEStrokeScale:RACEscoreof4.SeetheRaceGuidethathasbeencompletedforScenario#2.StudentsshouldarriveatthesamescorewhencompletingtheirownRaceGuide.Symptomsdemonstratedbysimulatedpatient:

● FacialPalsy:Scoreof1.Slightlyasymmetrical. ● Armmotorfunction:Scoreof1.Abletoraiseleftarmbutunabletoholdfor10seconds. ● Legmotorfunction:Scoreof1.Abletoraiseleftlegbutunabletoholdfor5seconds. ● Headand/oreyegazedeviation:Scoreof0.Nodeficit;Noheadorgazedeviationpresent. ● AssessforAphasia:Notassessed.(Onlyassessedforright-sideddeficits) ● AssessforAgnosia:Scoreof1.Thepatientrecognizeshisleftarmbutdoesnotacknowledgetheleftarmweakness.

TriageDecision:ThepatientispresentingwithsignsofastrokeasdemonstratedbyaRACEscoreof4.ThispatientshouldbetriagedandrapidlytransportedtotheclosestStrokeCenter.TransportanypatientwithaRACEscore>5totheclosestComprehensiveStrokeCenterorinterventionalstrokecentercapableofmechanicalthrombectomywithastentretriever,ifprotocolsallow.

RACEScenario2:ThecompletedRACEform.

SCORE1

SCORE0

SCORE1

TOTALSCORE 4

Scenario#3:Dispatch:Dispatchedtoanunknownmedicalatalibrary.ArrivetoFind:A44year-oldfemalepatientsittinginachairwithabookinherlap.Thelibrarianstatesthepatientisnotactingappropriately.Sheinitiallythoughtthepatientwasdrowsybutimmediatelycalled911whenshenoticedthepatienthadfacialdroop.

RACEStrokeScale:RACEscoreof7.SeetheRaceGuidethathasbeencompletedforScenario#3.StudentsshouldarriveatthesamescorewhencompletingtheirownRaceGuide.Symptomsdemonstratedbysimulatedpatient:

● FacialPalsy:Scoreof2.Completelyasymmetrical. ● Armmotorfunction:Scoreof2.Unabletoliftrightarm. ● Legmotorfunction:Scoreof2.Unabletoliftrightleg. ● Headand/oreyegazedeviation:Scoreof1.Present;unabletoshiftgazepastmidline. ● AssessforAphasia:Scoreof0.Patientisabletoperformbothtaskscorrectly. ● AssessforAgnosia:Notassessed(Onlyassessedforleft-sideddeficits)

SCORE2

SCORE1

SCORE0

TOTALSCORE 7

Scenario#4:Dispatch:Dispatchedtoapatientwithdifficultywalking.

ArrivetoFind:A59year-oldmalepatientalertandorientedtimes4sittingonaparkbench.Thepatientstatesthathewaswalkingwhenhedevelopedweaknessinhisleftarmandleftleg.Thepatientstatesthisbegan15minutespriorandhecalled911immediatelyaftertheonset.

RACEStrokeScale:RACEscoreof3.SeetheRaceGuidethathasbeencompletedforScenario#4.StudentsshouldarriveatthesamescorewhencompletingtheirownRaceGuide.

Symptomsdemonstratedbysimulatedpatient:● FacialPalsy:Scoreof1.Slightlyasymmetrical. ● Armmotorfunction:Scoreof1.Abletoraiseleftarmbutunabletoholdfor10seconds. ● Legmotorfunction:Scoreof1.Abletoraiseleftlegbutunabletoholdfor5seconds. ● Headand/oreyegazedeviation:Scoreof0.Nodeficit;Noheadorgazedeviationpresent. ● AssessforAphasia:Notassessed.(Onlyassessedforright-sideddeficits) ● AssessforAgnosia:Scoreof0.Patientrecognizesleftarmandacknowledgesleftarmweakness.

TriageDecision:ThepatientispresentingwithsignsofastrokeasdemonstratedbyaRACEscoreof3.ThispatientshouldbetriagedandrapidlytransportedtotheclosestStrokeCenter.TransportanypatientwithaRACEscore>5totheclosestComprehensiveStrokeCenterorinterventionalstrokecentercapableofmechanicalthrombectomywithastentretriever,ifprotocolsallow.

SCORE1

SCORE0

TOTALSCORE 3

Scenario#5:Dispatch:Dispatchedtoanursinghomeforapossiblestroke.

ArrivetoFind:A69year-oldfemalepatientalerttopersonlyingsupineinahospitalbed.Thepatientstatesthatherrightarmisweak.Staffstatestheynoticedasuddenonsetofweaknessinthepatient’srightarm.Thisbeganwhilethepatientwaseatinglunch20minutesprior.Staffassistedthepatienttoherroom.

RACEStrokeScale:RACEscoreof8.SeetheRaceGuidethathasbeencompletedforScenario#5.StudentsshouldarriveatthesamescorewhencompletingtheirownRaceGuide.

Symptomsdemonstratedbysimulatedpatient:

● FacialPalsy:Scoreof2.Completelyasymmetrical. ● Armmotorfunction:Scoreof2.Unabletoliftleftarm. ● Legmotorfunction:Scoreof2.Unabletoliftleftleg. ● Headand/oreyegazedeviation:Scoreof0.Nodeficit;Noheadorgazedeviationpresent. ● AssessforAphasia:Notassessed.(Onlyassessedforright-sideddeficits) ● AssessforAgnosia:Scoreof2.PatientdoesnotrecognizeleftarmANDdoesnotacknowledgeleftarmweakness.

RACEScenario5:ThecompletedRACEform.

SCORE2

SCORE0

SCORE2

TOTALSCORE 8

CitedReferences1. WadeS.Smith,MD,PhD;MichaelH.Lev,MD,FAHA;JoeyD.English,MD,PhD;EricaC.Camargo,MD,MMSc;Maggie

Chou;S.ClaiborneJohnston,MD,PhD;GilbertoGonzalez,MD,PhD;PamelaW.Schaefer,MD;WilliamP.Dillon,MD;WalterJ.Koroshetz,MD;KarenL.Furie,MD,MPH"SignificanceofLargeVesselIntracranialOcclusionCausingAcuteIschemicStrokeandTIA."Stroke(December,2009).Web.

2. Ossa,Natalia,MD,andDavidCarrera,MD."DesignandValidationofaPrehospitalStrokeScaletoPredictLargeArterialOcclusion."Stroke.AmericanHeartAssociation,26Nov.2013.Web.1Feb.2016.

apid rterial o clusion xam RACE - AmericanCME...symptoms of stroke, and improve stroke recognition...

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