When a stroke occurs, getting emergency care is of the utmost importance.
The sooner a patient receives stroke care, the better his or her chances
of survival and favorable long-term outcomes. As soon as a stroke patient
arrives at Regional Medical Center of San Jose, our
stroke care team rapidly assesses him or her using established guidelines.
The first set of assessment criteria involves the patient’s level
of consciousness. The clinician scores the patient from zero to three,
with zero indicating full alertness and responsiveness, and three indicating
complete unresponsiveness to stimuli. If the patient is conscious, the
clinician asks for the patient’s age and what month it is. A score
of zero indicates both answers are correct, one means that one answer
is correct, and two means that neither answer is correct. The last level
of consciousness assessment tests how well the patient can follow simple
commands. The patient is asked to open and close the eyes, and then to
grip and release the unaffected hand.
clinician evaluates the patient’s horizontal eye movements, such as by making eye contact with the patient and then encouraging eye
movement by physically moving from one side of the patient’s visual
field to the other. Zero indicates a normal gaze, one indicates partial
gaze palsy, and two indicates total gaze palsy.
The clinician then checks the patient’s visual field. He or she
holds up a finger and moves it across the upper and lower quadrants of
the visual field. This assessment of possible vision loss is crucial,
because stroke may result in blindness.
Since stroke can cause weakness or paralysis on one side of the body,
the clinician asks the patient to smile or raise the eyebrows to check
for symmetry. If the patient is poorly responsive, the clinician may use
stimuli to trigger a grimace response instead.
The last set of assessment criteria involves lifting each arm and leg
in turn. The patient is asked to keep the limb in the elevated position.
The clinician scores the patient based on whether the limb stays up, drifts
downward, or falls immediately.
Protocols-driven stroke care is available from Regional Medical Center
of San Jose. Our stroke care team coordinates with EMS personnel to prepare
for a patient’s arrival to facilitate immediate evaluations and
interventions. We urge residents of San Jose to call 911 for emergency
care if stroke signs develop; general questions of a non-emergent nature
can be directed to our hospital at (888) 762-8881.