stroke

STROKEJerry Axsom NREMT-P

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

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

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

Embolic stroke

Evolution = abrupt development completed stroke, steady progression

Onset = daytime, sudden Loc = client I s awake Contributing factors = cardiac disease

Embolic stroke

Neurologic deficits Maximal deficit at onset Paralysis Expressive aphasia , speech No seizures Duration = rapid improvements

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

TIA

Transient ischemic attack “ silent stroke” Visual deficits Blurred vision Diplopia ( double vision) Blindness in one eye, or tunnel vision

TIA

Motor deficits Transient weakness (arm, hand, or leg) Gait disturbance Sensory deficits Transient numbness ( face, arm, hand) vertigo

TIA

Speech deficits Aphasia ( no speech) Dysarthria ( slurred speech)

Signs and Symptomsof strokes

Facial Droop Slurred Speech One sided weakness Headache LOC Arm drift, weak hand grasp Breathing

stroke

Remember the ABC’S Airway Breathing Circulation

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

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

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

Stroke scale

Interpretation: if any 1 of these 3 signs is abnormal, the probability of a stroke is 72 %

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

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

Treatments for Stroke

Activate stroke team Order emergent CT scan of brain Obtain 12-lead ECG

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

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

Stroke Drugs

Alteplase (tissue plasminogen activator, recombinant ; t-PA)

Actilyse, Activase, Cathflo, Activase

Pharmacologic class: enzyme

Stroke

Goal from onset of symptoms to treatment 60 min or less.