Saturday, 7 February 2009

ASLS: All done and dusted

I set off at 07.15 thinking that I had bags of time to get to the hospital. After all the snow I thought I'd give myself extra time. Depending on which way you go it's no more than 40 miles. I opted to go the scenic route up country instead of the motorway. Big mistake, I turned left instead of straight on and ended up stuck in traffic for over an hour! I was soon on the last stretch thinking I would make it in time until I got to the hospital slip road. More traffic!!!!! Into the car park, skidding on the ice and to top it all I was given the directions to the wrong building. The ice & snow were so bad that you could hardly stand up and every footstep I took I was just waiting for that slip & crack of my hip. Luckily I didn't fall. I managed to get to the right building and lecture theatre a mere 15 minutes late. Not bad for a journey that should have taken an hour tops!

The room was full, mostly with unfamiliar faces and as I entered they all turned to look.

'Sorry, traffic was a nightmare' I said as I found myself a seat. At least I wasn't the only one late, a few others turned up a few minutes later.

The majority of us were from the ambulance service but there were also 3 A/E Dr's and 5 or 6 nurses. This was an uncommon sight because it's not often we do training together which is a shame. The only other multi disciplinary course I attended was a Paediatric Life Support course at our local hospital 4 years ago.

We were all given an Advanced Stroke Life Support course book and the course was soon under way. The main topics were stroke recognition and stroke thrombolysis.

The lecturers were a battalion chief firefighter/paramedic from Florida and another paramedic also from Florida who also teach for the University of Miami. It was like being back in the states. The course delivery was excellent and these guys really knew their stuff. It was funny when we were talking about treating and transporting the patient with regards to accents, they would say 'in rowte' and we would say 'on root', both meaning 'en route'. Apart from the different accents the treatment principals remained the same. Good Airway and breathing management if required and correction of sugar levels if hypoglycemic (Hypoglycemia is a common mimic of stroke so needs to be recognised and treated first). With stroke patients the key is recognising the symptoms, initiating rapid transport and giving the hospital a pre alert call. One of the lecturers said that in the Florida keys there are no hospitals offering a stroke thrombolysis service so these patients will be flown over 130 miles to a main hospital. He also said that recently he had 4 patients that fitted the criteria but by the time he flew into hospital they all recovered! They were all suffering TIAs (Transient Ischaemic Attack), this is basically 'Angina of the Brain'. A small clot temporarily lodges and blocks blood flow to a certain part of the brain this then produces the same signs and symptoms as a stroke. A TIA will usually resolve itself within an hour but can last for up to 24 hours. At least it shows that the system works because if these patients were indeed having a stroke they would have got the treatment within the time window which is 3 hours from onset of symptoms.

The reason why there is a strong emphasis on improving stroke care is because a lot of hospitals in the UK are now offering a stroke Thrombolysis service. The quicker we get these patients to hospital for this clot busting treatment the greater chance of reducing disability or even death. As Paramedics we can give this treatment to patients suffering from a heart attack but not in stroke patients as we are unable to determine whether it is caused by a clot or a bleed. These patients will need a CT scan to determine the type of stroke which in turn will determine the course of treatment.

A lot of the course was refreshing pre existing knowledge but also included more in depth examination techniques such as the MEND exam or 'Miami Emergency Neurological Deficit' exam. We already use the FAST exam, the MEND is just an improvement on that. There were practical skill stations so we could all practice and also scenarios for us to work through. We covered major stroke syndromes and stroke mimics as well as Thrombolysis. A local stroke consultant also gave a session on patient treatment and care when in hospital. Nice chap who seemed very pro Paramedic. He even brought the lunch in! Overall a very enjoyable day and if any one gets a chance to do this course in the future, do it!

And if there are any members of the public reading this remember: If someone develops sudden slurred/jumbled speech, facial droop and loss of power on one side of their body then call 999/911. Don't wait to see if it gets better! TIME IS BRAIN!

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