Pre-hospital differentiation of occlusive and hemorrhaging stroke

DragonClaw

DragonClaw

Emergency Medical Texan
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So I was thinking about how in the field we can't test for stroke types, only if one is present. Why?

If you have a heart attack, you can test troponin to tell how bad it is. If you have a dissection, you can check a D-Dimer.

Are there markers for strokes like this? I would imagine so. Maybe not.

Supposing there is, Why isn't there some BGL type machine that can tell you if it detects these markers? If they exist, do the pass the blood brain barrier?

Surely it would be expensive, but at the same time, what's the cost of a delayed stroke treatment, especially when people don't know even they were last normal.

Just a few thoughts.
 
VentMonkey

VentMonkey

Family Guy
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Stroke Ambulances (to my knowledge) have largely been a waste of time and money. I don’t know of any prehospital point-of-care marker to differentiate stroke types.

Also worth mentioning, the other markers you’re referring to are largely not utilized in the prehospital settings as tools such as 12-lead ECG’s, and a good solid set of hands on assessment skills (e.g., impending dissection signs exhibited upon assessment) can be effective enough to error on the side of caution, warranting proper definitive care.

Again, these truly time-sensitive, life-threatening prehospital emergencies are best handle by a quick, efficient assessment, prompt recognition, perhaps a diagnostic tool such as a 12-lead ECG if applicable, and rapid yet safe transport to the proper hospital.

There’s also cost and reimbursement factors often not considered in “adding more tools”. Cold, hard fact.
 
akflightmedic

akflightmedic

Forum Deputy Chief
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DragonClaw said:
If you have a heart attack, you can test troponin to tell how bad it is. If you have a dissection, you can check a D-Dimer.
Click to expand...

FYI, checking troponins are not exclusive for determining a MI or the severity of a MI. There are many disease processes which can cause elevated troponins. So a solid knowledge base, strong history and assessment, and other related tests are often indicated.

A d-dimer is routinely ordered, and usually for suspicion of a PE. Sure, it can be an indicator for dissection, however you will more often see the dimer for the patient presenting with sharp chest pain or new onset acute shortness of breath.
 
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