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Stroke Algorithm Cincinnati Prehospital Stroke Scale (CPSS)

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The American Heart Association has included the suspected stroke algorithm in its Advanced Cardiac Life Support (ACLS) course curriculum. Continued research provides both members of the community and healthcare providers with detailed information to better facilitate the care of a suspected stroke victim.

For first-time ACLS students, the American Heart Association has developed a video that demonstrates the importance of early recognition of strokes and how it relates to treatment. The Cincinnati Prehospital Stroke Scale and Glasgow Coma Scale are both used by healthcare providers to assess for symptoms of a stroke.

The Cincinnati Prehospital Stroke Scale (CPSS) checks three things. The first of the three is facial droop.  By asking the suspected stroke victim to smile the family member or healthcare provider can see whether their smile is equal on both sides or if one side is not moving.

After assessing for facial droop ask the patient to hold both of their arms out in front of them with the palms of their hands facing up. The patient should do this with their eyes closed for at least ten seconds. If their arms do not move at all, or if they move the same this part of the Cincinnati Prehospital Stroke Scale is normal. However, if one of their arms drifts down or is unable to move it would be an abnormal sign.

The final assessment of the patient suspected of having a stroke is speech. Ask the patient to speak and repeat a sentence. The sentence used in the CPSS is “You can’t teach an old dog new tricks”.  A normal finding would be all words are stated normally with no slurred speech. Abnormal findings would be slurred speech, wrong use of words, or the inability to speak at all. If the suspected victim has an abnormal result for any of the three parts of the Cincinnati Prehospital Stroke Scale the probability of stroke is 72%.

The Glasgow Coma Scale ( GCS ) also is a three-part assessment. In each of the three parts of the assessment, the patient is given
a score. Once all three assessments are completed the scores are added together to determine the severity of dysfunction. The first assessment is eye-opening of the patient. If the patient opens their eyes spontaneously they are given a score of 4. If the victim does not open their eyes spontaneously but does to either pain or verbal stimuli they are given a lower score. If they do not open their eyes to any of the above their score for this part of the Glasgow Coma Scale is 0.

Following the eye-opening assessment is the best verbal response assessment. The perfect score of 5 is given to the patient who is completely oriented and can carry on a normal conversation. The score decreases to a lower number if the patient is confused, making incomprehensible sounds, or using inappropriate words. If the patient is unable to speak he or she is given a zero in the best verbal response part of the GCS. The final assessment in the Glasgow Coma Scale is assessing motor response. If the patient can follow commands and move extremities normally the score is a 6. However, if the patient withdraws or presents with abnormal flexion or abnormal extension the score is less. If the patient has no motor response the score is 0. Finally, the healthcare provider adds the score from the eye-opening assessment, best verbal response assessment, and motor response assessment together. A perfect score is 15. Anything else would indicate some level of dysfunction.

The most important part of treating a victim suffering a stroke is early recognition and activation of the emergency response system. Using the Cincinnati Prehospital Stoke Scale and the Glasgow Coma Scale aids in determining what to do next in the American Heart Association Suspected Stroke Algorithm. For a complete video demonstration of the Cincinnati Stroke Scale Click Here.


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