ACUTE STROKE – Ischemic or Hemorrhagic

Did you know based on statistical epidemiology that every 40 seconds someone in the United States has a stroke? What’s more intriguing is that one out of six people will suffer a stroke in his or her lifetime. Therefore, everyone should be ready at all times because even with risk factors or no risk factors anyone may potentially have a stroke.

brain-001-1172516[1]

This is the principal reason why Palm Desert Resuscitation Education (PDRE) is steadfast in informing healthcare providers as well as the public at large about the etiology, risk factors, symptoms, signs, diagnostic tests, and possible treatment of a stroke or also known as cerebrovascular accident (CVA) considering that it is, in fact, a leading cause of death – it is currently the #5 cause of death in the United States – and adversely affects many people every year. Did you also know that it is actually one of main causes of disability among adults in the United States? For someone who has suffered and survived a major ischemic or hemorrhagic stroke, it is very disheartening to observe and experience the victim’s physical, mental, and/or social incapacity, especially in regards to his or her diminished daily activities of living, which we all might take for granted until it is partially or completely taken away from us due to a disabling but preventable medical condition.

We now offer Acute Stroke (Online) Classes for your education

How do we identify the telltale signs of an acute ischemic or hemorrhagic stroke?

How do we respond promptly with appropriate care and treatment based on your experience as a healthcare provider or even a non-healthcare provider, taking into account your limitations and knowing your clear roles and responsibilities as a rescuer in either an in-hospital setting or (most often) in an out-of-hospital setting where the majority of strokes happen?

THE PATHOPHYSIOLOGY OF A STROKE

The pathophysiology of a stroke occurs when the blood flow to the brain is fully interrupted by a clot (ischemic stroke) or when a vein or artery ruptures (hemorrhagic stroke). About 87% of all strokes in the United States are ischemic in nature and are due to atherosclerosis plaque build-up that abnormally accumulates along the blood vessels of the brain, which may lead to narrowing of the blood vessel lumen to the point of no blood perfusion and eventual neurological sequelae. What can also happen, at times, is that pieces of a benign atherosclerotic plaque can dislodge off and travel down to a narrow blood vessel(s) and may subsequently cause a stroke or brain tissue injury due to the lack of life-sustaining oxygen and nutrients in the affected area(s) of the brain. A sudden onset of stroke symptoms and signs then manifests in the victim that, if actually recognized early and immediately, may afford some precious time to get help immediately and can actually save someone’s life and/or prevent neurological debilitation from a stroke. This leads us to the importance and concept of understanding the stroke algorithm and chain of survival.

STROKE ALGORITHM AND CHAIN OF SURVIVAL

  1. Rapid recognition and reaction to the stroke warning signs is the first step in the stroke algorithm and chain of survival
  2. Rapid EMS dispatch
  3. Rapid EMS system transport and pre-arrival notification to the receiving hospital
  4. Rapid diagnosis and treatment in the hospital

As you can see from the stroke algorithm and chain of survival, as with acute coronary syndromes, timing is key! However, one has to coordinate the latter initial protocols with the 8 D’s of Stroke Care. By following diligently these crucial steps starting with recognition, responding to a stroke emergency as soon as possible can lead to rapid stroke treatment and may even save the victim’s life. There is a narrow window of time in which a stroke can be effectively and safely treated, for example, with fibrinolysis if it is an ischemic stroke (after a negative non-contrast CT imaging study of the brain and no other significant risk factors for excessive hemorrhage), consulting immediately with the neurosurgeon if it is a massive hemorrhagic stroke, or transferring the patient to the stroke unit in a hospital institution capable of managing any forms of stroke even after it has occurred. If that small window of time of therapy for a stroke is missed, then it could mean a difference between complete recovery, permanent disability, or even death. This is why carefully understanding the 8 D’s of Stroke Care is very imperative.

PDRE Pricing And Purchasing Options

As an authorized American Heart Association (AHA) training site, PDRE follows the authority in resuscitation science, research and training as published in the official AHA Guidelines for CPR and Emergency Cardiovascular Care (ECC). Our competent and experienced instructors interpret these Guidelines into the most premier quality training courses and programs in CPR, first aid and advanced emergency cardiovascular care for healthcare professionals, first responders, employees and the general public. We thank you for selecting PDRE as your preferred authorized AHA training site in Southern California.

This is a full listing of classroom-based and online courses as well as other services and products that PDRE offers. Please click on the specific course and program or services to view the full details and purchase options.

GROUP CLASSROOM-BASED COURSE
AND PROGRAM CATALOG

  • Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
GROUP CLASSROOM-BASED COURSE AND PROGRAM CATALOGINITIALRENEWAL
ACLS for Healthcare Providers
ACLS – Advanced Cardiovascular Life Support
     Classroom-based course

    • ACLS – Save Money! Seasonal Discount!
      • $170 Provider or Initial Class
      • $130 Update or Renewal Class
      • Required provider manual, sold separately.
      • Rules and regulations of this special offer are subject to change without prior notice.
      • Only applies to PDRE LLC customers and cannot be combined with any other coupons or discounts.
$280$200
     2015 ACLS Provider Manual or 2015 Handbook for ECC$50$50
     Total for the course and book$330$250
PALS for Healthcare Providers
PALS – Pediatric Advanced Life Support
     Classroom-based course

    • PALS – Save Money! Seasonal Discount!
      • $170 Provider or Initial Class
      • $130 Update or Renewal Class
      • Required provider manual, sold separately.
      • Rules and regulations of this special offer are subject to change without prior notice.
      • Only applies to PDRE LLC customers and cannot be combined with any other coupons or discounts.
$280$200
     2015 PALS Provider Manual$50$50
     Total for the course and book$330$250
BLS – Basic Life Support
BLS for Healthcare Providers (English & Spanish)
     Classroom-based course$50$45
     2015 BLS Provider Manual$25$25
     Total for the course and book$70$65
Workplace Training
Heartsaver® Bloodborne Pathogens
     Classroom-based course $65 $65
     2015 Heartsaver Bloodborne Pathogens Workbook (required)$15$15
     Total for the course and book$80$80
Heartsaver® First Aid (English & Spanish)
     Classroom-based course $75 $75
     2015 Heartsaver First Aid Provider Manual$10$10
     Total for the course and book$85$85
Heartsaver® CPR AED (ENGLISH & SPANISH)
     Classroom-based course $75 $75
     2015 Heartsaver CPR AED Provider Manual$10$10
     Total for the course and book$85$85
Heartsaver® First Aid CPR AED (English & Spanish)
     Classroom-based course $110 $110
     2015 Heartsaver First Aid CPR AED Provider Manual$10$10
     Total for the course and book$120$120
Heartsaver® First Aid CPR AED for K-12 Students, Faculty, & Staff
     Classroom-based course $110 $110
     Heartsaver First Aid CPR AED Provider Manual$10$10
     Total for the course and book$120$120
Heartsaver® Health & Safety Training
     Classroom-based course $225 $210
     2015 Heartsaver® Health & Safety Training Manual (optional) $25 $25
     Total for the course and book $250 $235
Heartsaver® Pediatric First Aid CPR AED (English & Spanish)
     Classroom-based course $110 $110
     2015 Heartsaver First Aid Provider Manual$10$10
     Total for the course and book$120$120
Airway Management
     Classroom-based course

$125

$150

ECG & Pharmacology Course
     Classroom-based course $145 $145
     ECG & Pharmacology Student Workbook (optional)$25$25
     Total for the course and book $170 $170
Neonatal
Resuscitation Program (NRP) for Healthcare Providers
     Classroom-based course

    • Neonatal Resuscitation Program (NRP): In-Person Hands-On Skills Evaluation Testing (i.e., Performance Checklist/Megacode) ONLY $80 per NRP Provider Learner.
      • The special offer does not include the current NRP provider manual.
      • Rules and regulations of this special offer are subject to change without prior notice.
      • Only applies to PDRE LLC customers and cannot be combined with any other coupons or discounts.
 $135$135
     Textbook of Neonatal Resuscitation, 7th Edition (required) $70$70
     Total for the course and book$205$205
Pediatric Emergency Advanced Assessment, Recognition and Stabilization (PEARS)
     Classroom-based course without the provider manual (required) $150$125
Sugar, Temperature, Airway, Blood Pressure, Lab Work, and Emotional Support (S.T.A.B.L.E.) Program
     Classroom-based course $120$100
     The S.T.A.B.L.E. Program Learner and Provider Manual, 6th Edition$65$65
     Total for the course and book $185$165
Management of Assaultive Behavior (MAB)/AB-508 Violence Prevention
     Classroom-based course $70$65
PDRE’s Dog Lovers First Aid and CPR/CPCR Course
     Classroom-based course $70$65
Intravenous (IV) Therapy & Blood Withdrawal Certification by Palm Desert Resuscitation Education LLC (PDRE) & Replenish 360 (R360) IV Hydration Therapy (OPEN FOR ENROLLMENT NOW!)

Classroom-based course

$280$200
Preventive Health & Safety Practices (PHSP) Training Program For Child Care Providers

Classroom-based course

$225

$120

$105

$225

$120

$105

CERTIFIED NURSE ASSISTANT (CNA)/NURSE ASSISTANT TRAINING PROGRAM (NATP) CURRICULUM BY SOUTHERN CALIFORNIA NURSING ACADEMY, INC. (SOCAL NURSING)

Classroom-based course

    • CNA/NATP – Full Tuition Payment 
    • CNA/NATP – Payment Plan – 2 Scheduled Installments
    • CNA/NATP – Payment Plan – 3 Scheduled Installments
$2,350

$1,175

$783.33

$2,350

$1,175

$783.33

PRIVATE CLASSROOM-BASED COURSE
AND PROGRAM CATALOG

  • Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
  • Private classroom-based courses charges may vary on season, location, and scheduling.
    • Private ACLS classroom-based courses = Additional $50 Fee
    • Private BLS classroom-based courses = Additional $30 Fee
    • Private Heartsaver classroom-based courses = Additional $30 Fee
    • Please call us to verify any extra fees and charges for private classroom-based courses at (760) 832-4277 or (909) 809-8199; email us at [email protected]; or fill out our questionnaire on our Locations & Contact Us informational page.
PRIVATE CLASSROOM-BASED COURSE AND PROGRAM CATALOGINITIALRENEWAL
ACLS for Healthcare Providers
ACLS – Advanced Cardiovascular Life Support
     Classroom-based course

    • ACLS – Save Money! Seasonal Discount!
      • $170 Provider or Initial Class
      • $130 Update or Renewal Class
      • Required provider manual, sold separately.
      • Rules and regulations of this special offer are subject to change without prior notice.
      • Only applies to PDRE LLC customers and cannot be combined with any other coupons or discounts.
$300$280
     2015 ACLS Provider Manual or 2015 Handbook for ECC$50$50
     Total for the course and book$350$330
PALS for Healthcare Providers
PALS – Pediatric Advanced Life Support
     Classroom-based course

    • PALS – Save Money! Seasonal Discount!
      • $170 Provider or Initial Class
      • $130 Update or Renewal Class
      • Required provider manual, sold separately.
      • Rules and regulations of this special offer are subject to change without prior notice.
      • Only applies to PDRE LLC customers and cannot be combined with any other coupons or discounts.
$300$280
     2015 PALS Provider Manual$50$50
     Total for the course and book$350$330
BLS – Basic Life Support
BLS for Healthcare Providers (English & Spanish)
     Classroom-based course$150$130
     2015 BLS Provider Manual$25$25
     Total for the course and book$175$155
Workplace Training
Heartsaver® Bloodborne Pathogens
     Classroom-based course$110$105
     2015 Heartsaver Bloodborne Pathogens Workbook (optional) $15$15
     Total for the course and book $125 $120
Heartsaver® CPR AED (ENGLISH & SPANISH)
     Classroom-based course $120 $120
     2015 Heartsaver CPR AED Provider Manual$10$10
     Total for the course and book$130$130
Heartsaver® First Aid CPR AED for K-12 Students, Faculty, & Staff
     Classroom-based course $155 $155
     Heartsaver First Aid CPR AED Provider Manual $10 $10
     Total for the course and book $165 $165
Heartsaver® Health & Safety Training
     Classroom-based course $225 $210
     2015 Heartsaver® Health & Safety Training Manual (optional) $25 $25
     Total for the course and book $250 $235
Heartsaver® Pediatric First Aid CPR AED (English & Spanish)
     Classroom-based course $155 $155
     2015 Heartsaver First Aid CPR AED Provider Manual $10 $10
     Total for the course and book $165 $165
Airway Management
     Classroom-based course

$125

$150

ECG & Pharmacology Course
     Classroom-based course $145 $145
     ECG & Pharmacology Student Workbook (optional) $25 $25
     Total for the course and book $170 $170
Neonatal
Resuscitation Program (NRP) for Healthcare Providers
     Classroom-based course

    • Neonatal Resuscitation Program (NRP): In-Person Hands-On Skills Evaluation Testing (i.e., Performance Checklist/Megacode) ONLY $80 per NRP Provider Learner.
      • The special offer does not include the current NRP provider manual.
      • Rules and regulations of this special offer are subject to change without prior notice.
      • Only applies to PDRE LLC customers and cannot be combined with any other coupons or discounts.
 $135$135
     Total for the course and book $205$205
Pediatric Emergency Advanced Assessment, Recognition and Stabilization (PEARS)
     Classroom-based course without the provider manual (required) $150$125
Sugar, Temperature, Airway, Blood Pressure, Lab Work, and Emotional Support (S.T.A.B.L.E.) Program
     Classroom-based course $120$100
     The S.T.A.B.L.E. Program Learner and Provider Manual, 6th Edition$65$65
     Total for the course and book $185$165
Management of Assaultive Behavior (MAB)/AB-508 Violence Prevention
     Classroom-based course $70$65
PDRE’s Dog Lovers First Aid and CPR/CPCR Course
     Classroom-based course $70$65
Intravenous (IV) Therapy & Blood Withdrawal Certification by Palm Desert Resuscitation Education LLC (PDRE) & Replenish 360 (R360) IV Hydration Therapy (OPEN FOR ENROLLMENT NOW!)

Classroom-based course

$280$200
Preventive Health & Safety Practices (PHSP) Training Program For Child Care Providers

Classroom-based course

$225

$120

$105

$225

$120

$105

CERTIFIED NURSE ASSISTANT (CNA)/NURSE ASSISTANT TRAINING PROGRAM (NATP) CURRICULUM BY SOUTHERN CALIFORNIA NURSING ACADEMY, INC. (SOCAL NURSING)

Classroom-based course

    • CNA/NATP – Full Tuition Payment 
    • CNA/NATP – Payment Plan – 2 Scheduled Installments
    • CNA/NATP – Payment Plan – 3 Scheduled Installments
$2,350

$1,175

$783.33

$2,350

$1,175

$783.33

ONLINE COURSE AND PROGRAM CATALOG

  • Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
ONLINE COURSE AND PROGRAM CATALOGINITIALRENEWAL
Courses for Healthcare Professionals
Acute Stroke (Online)
     Online course only with Access Key $60$55
Nonvalvular Atrial Fibrillation (Online)
      Online course only with Access Key $60$55
Workplace Training
Heartsaver® Bloodborne Pathogens (Online)
     Online course only with Access Key $70$70
     Skills Tests only (optional) $35$35
     Bundle package ($10 Savings!)

    • Purchase of both online course Access Key and Skills Tests*
 $95*$95*
Heartsaver® First Aid (Online Part 1) And Skills Tests
    Heartsaver® First Aid (Online Part 1) And Skills Tests$80$80
    Heartsaver® First Aid Skills Tests (Only if Online Part 1 is Complete)$40$40
    Heartsaver® First Aid (Online Part 1) $40 $40
Heartsaver® CPR AED (Online Part 1) And Skills Tests
   Heartsaver® CPR AED (Online Part 1) And Skills Tests $90$90
   Heartsaver® CPR AED Skills Tests (Only if Online Part 1 is Complete)$50$50
  Heartsaver® CPR AED (Online Part 1)$40$40
Heartsaver® Health & Safety Training
     Online course only with Access Key N/A N/A
     Skills Tests only N/A N/A
     Bundle package

    • Purchase of both online course Access Key and Skills Tests*
 N/AN/A
Heartsaver® Pediatric First Aid CPR AED (Online Part 1) And Skills Tests

Heartsaver® First Aid CPR AED (Online Part 1) and Skills Tests

   Heartsaver® (Adult/Pediatric) First Aid CPR AED (Online Part 1) And Skills Tests $110 $110
   Heartsaver® (Adult/Pediatric) First Aid CPR AED (Online Part 1) Skills Tests Only $60$60
   Heartsaver® (Adult/Pediatric) First Aid CPR AED (Online Part 1) $50$50
HeartCode® ACLS (Online Part 1) and Skills Tests
ACLS – Advanced Cardiovascular Life Support
    HeartCode® ACLS (Online Part 1) and Skills Tests$250$250
    HeartCode® ACLS (Online Part 1) Skills Tests Only$150$150
    HeartCode® ACLS (Online Part 1)$100$100
HeartCode® PALS (Online Part 1) And Skills tests
PALS – Pediatric Advanced Life Support
    HeartCode® PALS (Online Part 1) and Skills Tests$250$250
    HeartCode® PALS Skills Tests Only$150$150
    HeartCode® PALS (Online Part 1)$100$100
HeartCode® BLS for Healthcare Providers (Online Part 1) And Skills Tests
BLS – Basic Life Support
    BLS for Healthcare Providers (Online Part 1) and Skills Tests$90$90
    BLS for Healthcare Providers Skills Tests Only$50$50
    BLS for Healthcare Providers (Online Part 1)$40$40

HeartCode® BLS (Online Part 1)
    HeartCode® BLS (Online Part 1) and Skills Tests$90$90
    HeartCode® BLS Skills Tests Only $50 $50
    HeartCode® BLS (Online Part 1)$40 $40
Learn:® Rhythm Adult (Online)
     Online course only with Access Key$70$65
Learn:® Rhythm Pediatric (Online)
 Online course only with Access Key $60 $55
Learn:® Rapid STEMI ID (Online)
     Online course only with Access Key $70 $65

PROVIDER MANUALS

  • Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
PROVIDER MANUALSPRICE

 2015 HEARTSAVER FIRST AID PROVIDER MANUALS

 $10

 2015 HEARTSAVER CPR AED PROVIDER MANUALS

 $10

 2015 HEARTSAVER FIRST AID CPR AED PROVIDER MANUALS

 $10

 2015 HEARTSAVER PEDIATRIC FIRST AID CPR AED PROVIDER MANUALS

$10

2015 BLS PROVIDER MANUALS

 $25

2015 ACLS PROVIDER MANUALS

$50

2015 EMERGENCY CARDIOVASCULAR CARE (ECC) HANDBOOK

$50

2015 PALS PROVIDER MANUALS

 $60

 2015 PEARS PROVIDER MANUAL

$60

THE S.T.A.B.L.E. PROGRAM, LEARNER/PROVIDER MANUAL 6th EDITION

 $65

 TEXTBOOK OF NEONATAL RESUSCITATION (NRP) 7th EDITION

 $70

Note: Reference Cards Guides are also available upon request for purchase(s).

Note: Electronic Manuals in the form of E-Books are also available upon request for purchase(s).

Price may vary

OTHER PRODUCTS

  • Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
OTHER PRODUCTSPRICE
Emergency Disposable CPR Face Shield $1

Adhesive Vinyl Hard Hat Decal, Legend “CPR FIRST AID CERTIFIED AND TRAINED” (Graphic, 2-1/4″ Diameter, White on Red)

$2.50

Pocket Reference Card (for all of the disciplines)

$12

Adult CPR Pocket Resuscitator Mask

$15

Adult Ambu Bag (Bag Valve Mask/Device)

$40

Pediatric Ambu Bag (Bag Valve Mask/Device)

$45

OTHER SERVICES

  • Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
SERVICESPrice
Automated External Defibrillator (AED) Service Package for your Business or Home
Each AED Purchase + Standard Cabinet with Alarm
Philips HeartStart Home Defibrillator (AED)

  • Previous Retail Price: $1,995.00
  • PDRE Price: $1,100.00 ($895 Savings!)
  • Refer to the AED Service Package Plan for more information about this product
  • First Voice AED Basic Wall Standard Cabinet with Alarm
  • Previous Retail Price: $229.00
  • PDRE Price: $200.00 ($29 Savings!)
  • Pricing and rates does not include tax and shipping fees
$1,300
Labor and Installation Fee at your location

  • Mounting of AED and standard cabinet with alarm
  • Includes Accuform Signs Projection Sign, Legend “AED” with Graphic, 6” x 5” Panel, 0.10” Thick High-Impact Plastic
    • Previous Retail Price: $30.00
    • PDRE Price: $0.00 ($30 Savings!)
$150
Monthly AED Service Support Fee (Optional)

  • Includes access to AED Maintenance Plan
  • Available for one year contract

$30/month

$250/year

Classroom Based CPR Classes, First Aid, BLS, ACLS, and PALS Certification and Recertification Courses available for surrounding Palm Desert cities:

WEST FROM PDRE
Redlands (92373, 92374, 92375)
Morongo Valley (92256)
Cabazon (92230)
Banning (92220)
Beaumont (92223)
Yucaipa (92399)
San Jacinto (92581, 92582, 92583)
Hemet (92543, 92544, 92545, 92546)
Temecula (92589, 92590, 92591, 92592, 92593)
NORTH FROM PDRE
Twentynine Palms (92277, 92278)
Yucca Valley (92284, 92286)
Big Bear Lake (92315)
EAST FROM PDRE
Joshua Tree (92252)
Salton Sea (92275)
Brawley (92227)
El Centro (92243, 92244)
Blythe (92225, 92226)
Calexico (92231, 92232)
SOUTH FROM PDRE
Borrego Springs (92004)
Anza (92539)

Classroom Based CPR Classes, First Aid, BLS, ACLS, and PALS Certification and Recertification Courses available for surrounding Redlands area cities:

  • Fontana (92331, 92334, 92335, 92336, 92337)
  • Riverside (92501, 92504, 92505, 92502, 92503, 92506, 92507, 92513, 92514, 92515, 92516, 92517, 92519, 92521,92508, 92509, 92522)
  • Corona (92877, 92878, 92879, 92880, 92881, 92882, 92883)
  • Rancho Cucamonga (91730, 91701, 91729, 91737, 91739)
  • Upland (91784, 91785, 91786)
  • San Bernardino (92401, 92402, 92403, 92406, 92408, 92404, 92405, 92407, 92410, 92411, 92412, 92414, 92415, 92423, 92424, 92427, 92413, 92418)
  • Murrieta (92562, 92563, 92564)

Classroom Based CPR Classes, First Aid, BLS, ACLS, and PALS Certification and Recertification Courses available for surrounding Riverside cities:

  • Fontana (92331, 92334, 92335, 92336, 92337)
  • Riverside (92501, 92504, 92505, 92502, 92503, 92506, 92507, 92513, 92514, 92515, 92516, 92517, 92519, 92521,92508, 92509, 92522)
  • Corona (92877, 92878, 92879, 92880, 92881, 92882, 92883)
  • Rancho Cucamonga (91730, 91701, 91729, 91737, 91739)
  • Upland (91784, 91785, 91786)
  • San Bernardino (92401, 92402, 92403, 92406, 92408, 92404, 92405, 92407, 92410, 92411, 92412, 92414, 92415, 92423, 92424, 92427, 92413, 92418)
  • Murrieta (92562, 92563, 92564)

Classroom Based CPR Classes, First Aid, BLS, ACLS, and PALS Certification and Recertification Courses available for surrounding Orange County and Lake Forest cities:

  • Aliso Viejo (92637, 92656)
  • Anaheim (92801, 92802, 92803, 92804, 92805, 92806, 92807, 92808, 92809, 92812, 92814, 92815, 92816, 92817, 92825, 92831, 92832, 92850, 92870, 92880, 92899)
  • Anaheim Hills (92807)
  • Brea (92821, 92822, 92823, 92886)
  • Buena Park (90620, 90621, 90622, 90623, 90624)
  • Costa Mesa (92626, 92627, 92628, 92646, 92707)
  • Dana Point (92624, 92629)
  • Fountain Valley (92728)
  • Fullerton (90621, 90631, 92801, 92831, 92832, 92833, 92834, 92835, 92836, 92837, 92838)
  • Garden Grove (90680, 92703, 92840, 92841, 92842, 92843, 92844, 92845, 92846)
  • Huntington Beach (90742, 92605, 92615, 92646, 92647, 92648, 92649)
  • Irvine (92602, 92603, 92604, 92606, 92610, 92612, 92614, 92616, 92617, 92618, 92619, 92620, 92623, 92637, 92650, 92657, 92679, 92697, 92782, 92889)
  • La Palma (90623)
  • Laguna Beach (92651, 92652)
  • Laguna Hills (92637, 92653, 92654, 92656)

Classroom Based CPR Classes, First Aid, BLS, ACLS, and PALS Certification and Recertification Courses available for surrounding San Diego cities:

8 D’S OF STROKE CARE

  • Detection
  • Dispatch
  • Delivery
  • Door
  • Data
  • Decision
  • Drug/Device
  • Disposition

DETECTION OF A STROKE – SYMPTOMS AND SIGNS

Because many strokes occur at home, it is integral that family members and laypersons alike recognize the symptoms and signs of a stroke. It may happen that one second a person is doing fine, then all of a sudden he or she can turn for the worse. The rescuer must know that this is a case of a possible stroke by easily remembering the mnemonic F.A.S.T. as promoted by the American Heart Association (AHA) and Palm Desert Resuscitation Education (PDRE):

An important fact to understand, whether you are a healthcare provider or even a layperson (who does not have any form of medical background), is the Cincinnati Pre-hospital Stroke Scale that is a system utilized to identify and detect a potential stroke in a pre-hospital setting. Essentially, it assesses for the abnormal neurological symptoms and signs of motor weakness like unilateral facial drooping and arm drifting or numbness as well as aphasia’s such as speech difficulties (i.e., slurred speech) and/or comprehension problems (i.e. confusion and/or disorientation). As illustrated previously in the pictures above, at least one positive out of the three common symptoms and signs of the F.A.S.T. mnemonic may indicate that the patient is having an actual stroke and increases his or her risk by at least 72%.

DISPATCH

Once some or all of the symptoms and signs of a stroke are recognized, then calling 911 and activating the emergency medical response system (EMS) through a dispatcher becomes a rescuer’s next priority. It is of high urgency for emergency medical technicians, paramedics, firefighters, or other first responders to quickly arrive at the scene and assist a patient who has a life-threatening medical condition, like a suspected stroke or a sudden cardiac arrest, for example. The purpose of swiftly dispatching the medical emergency team (EMT) or rapid response team (RRT) is to improve the patient outcomes by identifying and treating early clinical deterioration. Of course, once the vital signs are obtained and other reversal causes are ruled out as fast as possible, these EMTs or RRTs can then transfer the patient with a positive pre-hospital stroke assessment (via the Cincinnati Pre-hospital Stroke Scale) to a medical institution capable of performing a STAT Head CT scan imaging study to rule out brain hemorrhage and, if clinically appropriate, provide and administer fibrinolytic therapy to reverse the damage in the affected brain tissues and prevent decompensation of the stroke patient. Certainly, a competent physician and/or advanced healthcare provider need to respond to the suspected stroke quickly even if it might be reversed 24 hours later if it is, let’s say, a Transient Ischemic Attack (TIA).

DELIVERY

The ensuing step is to rapidly deliver and divert the patient with a suspected stroke to a hospital or medical center with a CT san imaging study capabilities even if it is 10-15 minutes away. The EMS rescuers are hopeful that the periods of delivery to the medical institution capable of performing this STAT Head CT scan to look for a brain bleed is as minimally short as possible. Remember, time is essential and key for the brain and heart!

Another significant life-saving tool utilized by the EMTs and RRTs is a clear, concise radio communication of the patient’s current condition, clinical history, pertinent pre-hospital diagnostic study results and the estimated time of arrival to the destined emergency department (ED) team to quickly and efficiently triage the suspected stroke patient and swiftly prepare the stroke team, including the attending neurologist and stroke unit healthcare providers.

It cannot be over-emphasized enough that there is a very limited time of therapy to begin fibrinolytic therapy if indicated (e.g., immediate rtPA infusion administration). Getting the advanced notice of a suspected stroke patient from the EMS will make the ED staff and stroke team be poised and ready to deliver appropriate and urgent therapy.

FACE DROOPING Does one side of your face droop or is it numb? Try to smile.

FACE DROOPING Does one side of your face droop or is it numb? Try to smile.

 
ARM WEAKNESS Is one arm weak or numb? Try to raise both arms. Does one arm drift downward?

ARM WEAKNESS Is one arm weak or numb? Try to raise both arms. Does one arm drift downward?

 
SPEECH DIFFICULTY Is your speech slurred or are you unable to speak? Try to repeat a simple sentence like,

SPEECH DIFFICULTY Is your speech slurred or are you unable to speak? Try to repeat a simple sentence like, "The sky is blue." Can you say it correctly?

 
TIME TO CALL 9-1-1 If you or a loved one has any of these symptoms, even if the symptoms go away, call 9-1-1 and go to the hospital immediately

TIME TO CALL 9-1-1 If you or a loved one has any of these symptoms, even if the symptoms go away, call 9-1-1 and go to the hospital immediately

DOOR

From the delivery to the ED door, the suspected stroke patient must be clinically assessed again within 10 minutes. Some medical institution may take the patient directly to the CT scan if there is a high probability of a stroke based on the history of present illness and current abnormal neurological symptoms and signs of the patient as evaluated by the healthcare provider(s).

Of course, in any acute illness as in a stroke case, the “ABCs” are critical in the initial assessment and at times provide prognosis of the patient’s acute life-threatening medical condition to prevent deterioration to a worse clinical state. Unstable vital signs should be considered, such as hypoxemia, and blood studies should be ordered which may include serum glucose levels, electrolytes, CBC, and coagulation findings just to name a few urgent laboratory studies. Just a note, even if the EMS may have performed a STAT finger stick analysis of the patient’s serum glucose levels, the blood sugar levels should be taken again in the ED to look for hypoglycemia or hyperglycemia, especially in both type 1 and type 2 diabetic patients. ED personnel must also rule out other medical causes by performing a portable CXR to look for pulmonary causes of the patient’s grave medical condition and a 12-lead ECG to identify thrombosis as in a recent heart attack or myocardial infarction (e.g., UA/NSTEMI or STEMI) or a catastrophic arrhythmia as another potential cause of the patient’s abnormal neurological symptoms and signs. Nevertheless, performing other diagnostic studies like a CXR and/or ECG should not delay directing the patient to have an immediate STAT Head CT scan imaging study unless there is a very high probability that the medical condition is, possibly, an acute coronary syndrome (ACS) or other life-threatening medical conditions, for example.

DATA

Preferably, during the first 25 minutes of a suspected stroke patient’s arrival at the ED door as per the most current and up-to-date guidelines by the American Heart Association (AHA) and the majority of medical associations, the emergency department physician must perform a thorough medical and clinical history, a targeted physical examination with an emphasis on the neurological examination (specifically, ideally in conjunction with the National Institutes of Health Stroke Scale or just NIHSS), and actually determine a time of symptom onset based on the data provided initially by the patient (if possible), patient’s family members or friends, innocent bystanders, EMS, and/or other healthcare providers involved with the care of the suspected stroke patient.

In terms of the NIHSS, it is a very methodical evaluation tool that offers a quantifiable measure of stroke-related neurological deficit. In accordance with the NIH Stroke Scale International as indicated in the organization’s educational website – http://www.nihstrokescale.org/ – the NIHSS is 15-item neurologic examination stroke scale that can be completed in less than 10 minutes or so to clinically assesses the suspected stroke patient’s level of consciousness, language, neglect, visual-field loss, extra-ocular muscle movement, motor strength, ataxia, dysarthria, and sensory loss among the most common typical or atypical signs of a stroke.

Clear indicators through the quantifiable measures of the NIHSS or as per the judgement of the ED physician that highly suggests a stroke are a signal to urgently perform a STAT Head CT scans imaging study preferably within 45 minutes of the patient’s arrival at the ED door. The clock is ticking.

DECISION

If there is a positive intracranial hemorrhage(s) from the Head CT scan, then the stroke team will not be able to provide fibrinolytic therapy and must consult immediately with the neurovascular surgeon and stroke team in case the massive brain bleed may be dangerously life-threatening, such as one that shows a midline shift of the brain or hypovolemic shock, that may likely lead to sudden death. However, if there is a normal Head CT scan that is negative for brain hemorrhage, this suggests an acute ischemic stroke that directs the advanced healthcare provider to determine and decide whether rtPA therapy is appropriate or pursue other avenues of therapy if “clot busters” are not recommended.

A repeat neurological examination, stabilization of vital signs, and the fibrinolytic checklist are highly warranted moving forward for the patient’s safety and clinical condition because it basically tells you if the stroke patient is, on one hand, a candidate for rtPA or other direct clotting factor inhibitors or, on the other hand, may not receive anticoagulation due to their past medical history of severe bleeding and/or increased risk factor for uncontrollable hemorrhage. If and only if the stroke patient is cleared based on the comprehensive fibrinolytic checklist and the window of therapy for fibrinolysis is still within 3 hours of symptoms onset, then the advanced healthcare provider must then ask for consent directly from the patient, patient’s spouse/family members, or power-of-attorney/healthcare proxy (ethically speaking, if the patient is not competent or does not have capacity to make medical decisions and care for his or her own well-being).

Some contraindications to receiving fibrinolytic therapy are the following but are not exhaustive:

  • Brain hemorrhage based on the Head CT scan results
  • Prior CVA(s) or stroke(s)
  • Abnormal blood vessels in the brain, such as major intracranial aneurysms
  • Recent bleeding, as in the gastrointestinal system or other areas of the body prone to hemorrhage
  • History of clotting and coagulation problems
  • Recent surgery, especially neurosurgery
  • Recent major accidents
  • Current therapy with anticoagulation

DRUG/DEVICE & DISPOSITION

Before initiating fibrinolytic therapy and if it is clinically appropriate, it is customary to get a medical consent from the patient or possibly the patient’s family members or healthcare proxy who are there to support the stroke patient because there is a small chance of a major and fatal cerebral bleed after initiating anticoagulation. Even if the risk of an intracranial hemorrhage with clot busters is less than 5%, there should be consideration that a hemorrhagic stroke or excessive bleeding may happen. However, the upside to fibrinolytic therapy in an acute ischemic stroke is that it may break up the atherosclerotic plaque that is narrowing one or more of the arteries of the brain, potentially restoring or improving blood perfusion to the other areas of the brain. It actually improves neurological recovery by 30% if the fibrinolytic therapy is given within the recommended 3 hours of neurological symptom onset in an acute ischemic stroke, outweighing potential life-threatening risks involved with anticoagulation. Regardless, it is better to make the window of 3 hours for fibrinolytic therapy but some suggests 4.5 hours may also be appropriate in other instances. In any case, the earlier the administration of anticoagulation in an acute ischemic stroke, the more likely that the patient recovers without neurological deficits or disability.

PRIMARY PREVENTION & SECONDARY PREVENTION OF STROKE

It is important to emphasize that no treatment is perfect and, sometimes, even if everything is done right, the patient might not even survive the stroke or may still suffer neurological problems and disability, which far too often can lead to a very low-quality of life not only experienced by the stroke patient but as well as their caretakers, usually the family members and friends who will most likely have great difficulty even just trying to assist in their loved one’s daily activities of living. Therefore, it is better to prevent the stroke than actually treating it, as is the case in most acute or chronic medical conditions, whether they are debilitating or not. The risk factors for a stroke must be minimized through primary prevention by averting disease or injury before it ever occurs. First and foremost, primary prevention can happen through mass education of the public with healthy and safe habits that aids in stroke deterrence. In addition, secondary prevention is also vital in stroke prevention by aiming to reduce the impact of a disease or injury by following up with regular examinations by competent healthcare providers who screen potential stroke patients with diagnostic tests to detect disease in its earliest stages and/or provide pharmacological therapy to prevent further cerebrovascular accidents in combination with primary prevention to teach their patients ways to decrease, lessen, or completely get rid of their lifetime risk factor(s) for a stroke.

Naturally, as stated by the Stroke Association, particular risk factors for a stroke cannot be altered as in the patient’s advanced age, hereditary/family history, race, sex (gender), and prior stroke, TIA or heart attack. Nevertheless, the other side of the coin suggests that it is wise to avoid or prevent a stroke entirely by changing one’s lifestyle to avert uncontrolled high blood pressure; stopping or minimizing cigarette smoking; managing diabetes mellitus appropriately; improving diet through portion control, decreasing fatty foods and red meat, reducing salt intake, and eating more fruits and vegetables; increasing physical activity; and, lastly, losing weight by being within the recommended average body max index for one’s weight and height. Clearly, there may be other less familiar risk factors of stroke such as medical conditions that increase coagulation in the body (e.g., atrial fibrillation and Sickle Cell Disease just to mention a few) or other medical problems that mandate a patient to take daily blood thinners to prevent or treat thrombosis (i.e., atrial fibrillation, deep vein thrombosis, pulmonary embolisms, and other hypercoagulable states). There are other rare risk factors for a stroke such as illicit drug abuse and alcohol abuse that most people do not even think about. Going further than substance abuse risk factors for a stroke are other, less well-documented stroke risk factors like living in a specific geographic location and low socioeconomic area where stroke most often occurs. The latter risk factors for a stroke may be one of the influences in why some people are more prone to a stroke and why others are not. They are something to think about.

STROKE EDUCATION IS IMPORTANT FOR EVERYONE!

It is truly important that families and healthcare providers alike recognize the symptoms and signs of a stroke by easily remembering the mnemonic F.A.S.T. to be able to save precious time before the victim deteriorates immediately. Remember, a stroke can happen to anyone and it may even happen to be your family member or close friend who is directly or indirectly affected by it, so please help the Palm Desert Resuscitation Education (PDRE) and American Heart Association (AHA) inform everyone in your community to know and understand the importance of stroke education and how to prevent it in the first place!

Stroke Stats

We now offer Acute Stroke (Online) Classes for your education

Cardiovascular Disease and Acute Stroke are one of the leading causes of death in the United States. Knowing CPR can potentially save someone’s life after a heart attack or a stroke, which why it is also important to know how you can help someone in cardiopulmonary arrest with basic CPR, even if it is “hands-only CPR.” This is a great transition to being cognizant of a few vital facts about why CPR is critical to know, especially in an out-of-hospital setting.

Who Can You Save With CPR?

The life you save with CPR is most likely to be a loved one.

  • 4 out of 5 cardiac arrests happen at home.
  • Statistically speaking, if called on to administer CPR in an emergency, the life you save is likely to be someone at home: a child, a spouse, a parent or a friend.

Why Take Action?

  • Failure to act in a cardiac emergency can lead to unnecessary deaths.
  • Effective bystander CPR provided immediately after sudden cardiac arrest can double or triple a victims chance of survival, but only 46% of those victims get CPR from a bystander.
  • Only about 10% of people who suffer a cardiac arrest outside the hospital survive.
WEST FROM PDRE
Redlands (92373, 92374, 92375)
Morongo Valley (92256)
Cabazon (92230)
Banning (92220)
Beaumont (92223)
Yucaipa (92399)
San Jacinto (92581, 92582, 92583)
Hemet (92543, 92544, 92545, 92546)
Temecula (92589, 92590, 92591, 92592, 92593)NORTH FROM PDRE
Twentynine Palms (92277, 92278)
Yucca Valley (92284, 92286)
Big Bear Lake (92315)
EAST FROM PDRE
Joshua Tree (92252)
Salton Sea (92275)
Brawley (92227)
El Centro (92243, 92244)
Blythe (92225, 92226)
Calexico (92231, 92232)SOUTH FROM PDRE
Borrego Springs (92004)
Anza (92539)