Stroke & DNR Protocol

Question 1

F.A.S.T. for Stroke

Answer 1

Face Drooping
Arm Weakness
Speech Difficulties
Time to Call

Question 2

Which CTAS level and above is a contraindication for Acute Stroke Protocol?

Answer 2

CTAS Level 1 and/or uncorrected airway, breathing or circulatory problem.

Question 3

Under what circumstances will an Airway, Breathing, or Circulatory problem NOT be a contraindication for Acute Stroke Protocol?

Answer 3

Problem was corrected prior to transport

Question 4

When will a patient with strokes symptoms that have RESOLVED, still qualify to be transported to a Designated Stroke Centre?

Answer 4

Patients whose symptoms improve significantly or resolve during transport will continue to be transported to a
Designated Stroke Centre.

Question 5

Blood Sugar <3 mmol/L is a contraindication for transport to a Designated Stroke Centre unless…

Answer 5

Symptoms persist after correction of blood glucose level, the patient is not contraindicated.

Question 6

What Glascow Coma Scale (GSC) level is a contraindication for Acute Stroke Protocol?

Answer 6

Glasgow Coma Scale <10.

Question 7

What duration of out of hospital transport is a contraindication for Acute Stroke Protocol?

Answer 7

Duration of out of hospital transport will exceed two hours

Question 8

What about a patient with a DNR would trigger a contraindication for Acute Stroke Protocol?

Answer 8

Terminally ill or palliative care patients are contraindicated for…

Question 9

When is a seizure a contraindication for Acute Stroke Protocol?

Answer 9

Seizure at onset of symptoms or observed by paramedics.

Question 10

DNR

For the purposes of the DNR Protocol, CPR includes

Answer 10

All the things!
* compressions
* defib
* vent
* airways
* intubation
* pacing
* resuscitation drugs

Question 11

DNR

What does a valid DNR mean for the paramedic

Answer 11

paramedic will not initiate any ‘CPR’ related interventions

Question 12

DNR

Valid DNR forms has this one key thing prior to completion

Answer 12

pre-printed serial number

Question 13

DNR

A completed DNR form contains these key things

Answer 13

1. pt first and last name, and
2. Checked box for condition met for the DNR
3. Signors key details:
   * check box with medical designation of signor
   * Printed name
   * signature of signor
4. date

who/why/authority/when

Question 14

DNR

Can a paramedic accept a copy of the DNR?

Answer 14

Yes, a valid copy of the DNR is as acceptable as the original

Question 15

DNR

When will a paramedic ignore the DNR

Answer 15

• not complete
• pt expresses a wish to be resusitated if they arrest (can be clear or ambiguous)

Question 16

DNR

With a valid DNR, what care must the paramedic provide?

Answer 16

PT management necessary for comfort or alleviate pain as req’d by the pt medical condition

Question 17

DNR

Upon death, the paramedic shall…

Answer 17

1.note the time
2. notify CACC/ACS
3. follow deceased pt standard

Question 18

Deceased PT Standard

Code 5 - list acceptable types

Answer 18

1. decap, transection, visible decomp, putrefaction; or
2. VSA &
   * grossly charred
   * open head/torso
   * gross rigor
   * dependent lividity