Beef Up Your Neuro Exam! with Chip Lange
"You can't teach an old dog new tricks" is clearly repeated by an elderly man who's family got concerned he was having a stroke when they noticed some gait ataxia. EMS does a quick Cincinnati Stroke Scale and doesn't detect any deficits, 12 lead looks normal, and blood glucose is within normal limits. Should he be evaluated in the emergency room? Should EMS be concerned about a central lesion? Does a negative Cincinnati mean the patient is not having a CVA?
I would argue that while the FAST exam is a great tool for the public to quickly identify stroke symptoms, as healthcare professionals, we should be performing a more thorough neurological exam. Our service a few years ago did extensive training on the NIH stroke scale. Our goal was to speak the same language as the hospitals in which we were taking and delivering patients from. The issue of subjectivity and intra-operator reliability comes into question whenever I discuss the NIHSS. I would argue that the exact score is not as important as is the relay of information & communication between providers.