The FAST stroke screen (Facial drooping, Arm weakness, Speech difficulty, Time to call) was developed as a method of streamlining the triage of patients to determine if they have had a stroke. While this is a good start to identifying acute stroke symptoms, evidence has suggested that there are situations when a patient needs a more comprehensive examination to screen for stroke symptoms; just using FAST may result in a physician missing certain symptoms of a stroke.
Introduction to SAVES
A new stroke screen using the acronym SAVES is designed to help physicians and first responders to pinpoint the signs of a stroke quickly and efficiently. SAVES stands for Smile, Arms, Vision, Even balances and Speech — all key indicators that a person might have suffered from a stroke.
An asymmetrical smile may indicate the patient should be treated as a possible stroke victim. Cortical deficits often affect the lower region of the face, while patients with afflictions like Bell’s palsy or similar conditions typically present with weakness in both the lower and upper aspects of the face. If there is any doubt, however, a stroke alert should be called.
A quick screen for sensory and motor function of patients is monitoring if there is a drift of the arms. The patient is asked to hold their arms in a supine fashion then close their eyes for 10 seconds. A slow downward drift of one side indicates that the patient should be placed under a stroke alert. Another screen involves having the patient hold their hands in front of them with their palms facing outward toward the physician. If there is a slow drifting of their fingers within 10 seconds of them closing their eyes, a stroke is likely indicated.
Patients presenting with blurred or double vision could indicate a stroke. However, using a visual field test is a more accurate indicator of the condition. The patient focuses on the physician’s nose as one or two fingers are held up in just out of the direct field of vision of the patient. Both upper and lower visual quadrants on both sides should be tested.
This portion of the screen is to determine if the patient has an apraxic gait. Physicians should look for a gait and stance that is wide based as they spread their legs to try to maintain their balance. Staggering and torso correction might also be noted. While dizziness or imbalance is certainly a symptom of a stroke, it is advised to be used in conjunction with another stroke symptom(s) as to not call an unnecessary stroke alert.
Speech is measured in two ways: aphasia (affects the expression or understanding of the written language) and dysarthria (affects the articulation of speech). The type of speech issues can also indicate where the stroke occurred. The frontal lobe of the brain is responsible for articulation so deficits in that area indicate a stroke has occurred in that region, while temporal lobe is where comprehension is centered, physicians can assume that a stroke has taken place in that area of the brain.
The easy-to-remember stroke screen, SAVES, provides physicians and first responders with valuable information in a simple and timely manner. This can lead to a quicker stroke alert and a better outcome for patients. TeleSpecialists’ average time from receiving the stroke alert call to physician arriving to tend to the patient via video cart to the patient’s bedside is 4 to 6 minutes.
For more information on how TeleSpecialists can create or enhance your TeleStroke program, visit our website at www.tele-specialists.com.
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