MIME-Version: 1.0 Content-Location: file:///C:/2671C674/AP24.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Los Angeles Prehospital Stroke Screen (LAPSS)

Los Angeles Prehospital Stroke Screen (LAPSS)

 

= 1.&n= bsp;      Patient Name:&nbs= p;  _________________________________  _________________________________

(Last= name)        &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;      (First name)

 

= 2.&n= bsp;      Information / History from:           [  ] Patient         [  ] Family Member         [  ] Other

 

____= _____________________________        _________________________________

(Name= - if other than patient)    =             &nb= sp;            =             &nb= sp;            =     (Phone)

 

= 3.&n= bsp;      Last known time patient was at baseline or deficit free and awake:

 

____= _____________________________        _________________________________

(Mili= tary time)      &n= bsp;            = ;            &n= bsp;            = ;            &n= bsp;          (Date)

 

SCREENING CRITERIA<= /span>

     YES=                       UNKNOWN            = ;          NO

4.    Age > 45 years            =             [=   ]             [  ]&= nbsp;            [  ]

 

5.    History of seizure or epilepsy absent [  ]&= nbsp;            [  ]&= nbsp;            [  ]

 

6.    Symptoms duration less than 24 hours  [=   ]             [  ]&= nbsp;            [  ]

 

7.    At baseline, patient is not           [  ]&= nbsp;            [  ]&= nbsp;            [  ]
wheelchair bound or bedridden

8.    Blood glucose between 60 and 400      [  ]&= nbsp;           [  ]           &nb= sp; [  ]

 

9.    Exam: LOOK FOR OBVIOUS ASYMMETRY

  NORMAL    RIGHT        &nb= sp;    LEFT

Facial smile / grimace    &nbs= p;    [=   ]      [  ] Droop    &n= bsp;   [  ] Droop

Handgrip        &= nbsp;              [=   ]      [  ] Weak     &n= bsp;   [  ] Weak                 &= nbsp;    &n= bsp;                 [  ]&= nbsp;     [  ] No grip      [=   ] No grip    &nb= sp;

Arm strength      = ;             [=   ]      [  ] Drifts down =  [  ] Drifts down

  [=   ]      [  ] Falls fast   [  ] Fa= lls fast

 

Based on exam, patient has only unilateral (not bilateral) weakness: &= nbsp;           &nbs= p;            &= nbsp;       [  ] YES            = [  ] NO

 

= 10.&= nbsp;  Items 4, 5, 6, 7, 8, 9 all YES’s (or unknow= n) - LAPSS screening criteria met:   [  ] YES            = [  ] NO

 

= 11.&= nbsp;  If all of the LAPSS criteria are met, alert the receiving facility of a possible stroke patient as early as possible and co= mplete a Thrombolytic Screening Form (CVA).  If not, then return to the appropr= iate treatment protocol.

 

(Note: the patient may be experiencing a stroke even if the LAPSS criteria are not met.)

 

= 12.&= nbsp;  Time LAPSS Exam Performed:   Military Time: _________________________________

 

= 13.&= nbsp;  Form Completed by: _________________________________________________________=