stroke
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STROKEJerry Axsom NREMT-P
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Types of strokes
Ischemic stroke = caused by the occlusion of a cerebral artery by either a thrombus or an embolus.
About 80% of strokes are ischemic
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Thrombotic stroke
Intermittent improvement between episodes of worsening
Onset = daytime (10am- 12pm), gradual (minutes to hours)
Loc = patient is awake Contributing associated factors =
hypertension, atherosclerosis Prodrominal symptoms = transient
ischemic attack
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Thrombotic Stroke
Neurologic deficits deficits during the first few weeks Slight headache Speech deficits Visual problems Confusion No seizures Duration = improvements over weeks to
months, permanent deficits possible
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Embolic stroke
Evolution = abrupt development completed stroke, steady progression
Onset = daytime, sudden Loc = client I s awake Contributing factors = cardiac disease
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Embolic stroke
Neurologic deficits Maximal deficit at onset Paralysis Expressive aphasia , speech No seizures Duration = rapid improvements
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Hemorrhagic stroke
Evolution = usually abrupt onset Onset = daytime , sudden may be
gradual if caused by hypertension Loc = deepening stupor or coma Contributing associated factors =
hypertension, vessel disorders Neurologic deficits = focal deficits sever Usually have seizures Duration = permanent neurologic deficits
possible
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TIA
Transient ischemic attack “ silent stroke” Visual deficits Blurred vision Diplopia ( double vision) Blindness in one eye, or tunnel vision
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TIA
Motor deficits Transient weakness (arm, hand, or leg) Gait disturbance Sensory deficits Transient numbness ( face, arm, hand) vertigo
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TIA
Speech deficits Aphasia ( no speech) Dysarthria ( slurred speech)
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Signs and Symptomsof strokes
Facial Droop Slurred Speech One sided weakness Headache LOC Arm drift, weak hand grasp Breathing
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stroke
Remember the ABC’S Airway Breathing Circulation
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Stroke
Cincinnati Stroke scale Facial Droop( have the pt. show teeth or
smile) Normal- both sides of face move equally Abnormal- one side of face does not
move as well as the other side
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Stroke scale
Arm Drift (pt. closes eyes and extends both arms straight out for 10 seconds)
Normal – both arms move the same or both arms do not move at all
Abnormal- one arm does not move or one arm drifts down compared with the other
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Stroke Scale
Abnormal speech( have pt. say “you can’t teach an old dog new tricks”)
Normal – patient uses correct words with no slurring
Abnormal- patient slurs words, uses the wrong words, or is unable to speak
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Stroke scale
Interpretation: if any 1 of these 3 signs is abnormal, the probability of a stroke is 72 %
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Treatments for a stroke
Support ABC’S, GIVE OXYGEN Perform prehospital stroke assessment Establish time when patient last known to
be normal Transport, consider going to a stroke unit
if appropriate Alert hospital as soon as known Check glucose
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Treatments for Stroke
Immediate general assessment and stabilization
Assess ABC’S, vital signs Provide oxygen if hypoxemic Obtain IV access if not already done, and
blood samples Check glucose, treat if indicated Perform neurologic screening assessment
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Treatments for Stroke
Activate stroke team Order emergent CT scan of brain Obtain 12-lead ECG
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If Hemorrhage noted
Consult neurologist or neurosurgeon Begin stroke pathway Admit patient to stroke unit Monitor B/P Monitor neurologic status Monitor glucose, treat if needed
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If no hemorrhage noted
Check for fibrinolytic exclusions History of stroke, or head bleed Internal bleeding Use cautiously in patients receiving
anticoagulants Patients 75 and older During pregnancy
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Stroke Drugs
Alteplase (tissue plasminogen activator, recombinant ; t-PA)
Actilyse, Activase, Cathflo, Activase
Pharmacologic class: enzyme
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Stroke
Goal from onset of symptoms to treatment 60 min or less.