FAST-VAN Stroke Screening Assessment Tool

Introduction

• Presenters: Ruth Whalen (Clinical Nurse Specialist, Saskatoon Health Region), Sanchea Wazalu (Senior Neurology Resident)
• Focus: Assessment tool for large vessel occlusion strokes

Importance of Stroke

• Third leading cause of death in Canada
• Mortality Rates:
  • 20-30% of stroke patients die within 30 days
  • 40% die within the first year
• Leading cause of disability
• Occurs every 9 minutes
• Economic impact through medical costs, lost wages, and reduced productivity

Types of Stroke

• Ischemic Stroke:
  • Caused by large vessel occlusion (thrombus within vessel or embolus)
  • Focus of FAST-VAN tool
• Hemorrhagic Stroke:
  • Intercerebral or aneurysmal subarachnoid hemorrhage
• Transient Ischemic Attack (TIA):
  • Symptoms last minutes to an hour, no permanent damage

Stroke Pathophysiology

• Core Area: Immediate tissue death due to lack of blood flow
• Penumbra: Area around the core that can potentially be saved

Diagnostic Tools

• CT of the Head: Looks for acute ischemic changes
• CT Angiogram: Identifies large clots in blood vessels

Treatment and Challenges

• Time is Brain: Prompt treatment is crucial
• Standard Treatment:
  • TPA (Tissue Plasminogen Activator) within 4.5 hours
  • Strict criteria limit candidates
• New Therapy:
  • Endovascular therapy (2015 trials)
  • Performed by neurosurgeons or interventional neuroradiologists
  • Access via femoral artery to remove clots

Endovascular Therapy Candidates

• Confirmed large vessel occlusion
• Small infarct area
• Last known normal < 12 hours

Stroke Centers in Saskatchewan

• Primary Stroke Centers: CT scanners, advanced imaging
• Tertiary Stroke Center: Offers endovascular therapy
  • Located at Royal University Hospital in Saskatoon

FAST-VAN Screening Tool

• Purpose: Identify large vessel occlusions for rapid transfer to Saskatoon

FAST Assessment

• Components:
  • Facial drooping
  • Arm weakness (unilateral)
  • Slurred or jumbled speech
• Outcome: Positive FAST indicates potential stroke

VAN Assessment

• Components:
  • Vision: Gaze deviation unable to cross midline
  • Aphasia: Loss of ability to express or understand speech
  • Neglect: Ignoring one side of the body
• Outcome: Positive VAN (one or more signs) indicates potential large vessel occlusion

Implementation

• FAST-VAN screen for better triage to endovascular therapy
• Positive FAST and one positive VAN sign indicates potential for endovascular intervention

Conclusion

• Contact Info: Provided for further questions
• FAST-VAN tool aims to improve stroke care and outcomes