What is a stroke?

• Interruption of blood flow to the brain that prevents brain cells from getting enough oxygen, thus damaging or killing them

Ischemic/Occlusive

• Clot in artery supplying the brain, preventing blood flow to the brain

• 85% of strokes are ischemic

Hemorrhagic• Bleeding in the brain that increases ICP

• Only 15% of strokes are hemorrhagic, but 40% of all stroke deaths are caused by hemorrhagic strokes

• aka “mini stroke”

• blood flow to the brain is blocked for only a short time (usually no more than 5 minutes)

• warning sign of a future stroke - more than a third of people who have a TIA end up having a major stroke within 1 year if they don’t receive treatment, and 10%-15% will have a major stroke within 3 months of a TIA

Risk Factors• Age is the single most important risk factor for stroke. The older you are, the

more likely you are to have a stroke.

o This pertains to faculty and staff, nontraditional students, visitors, etc.

• High BP/ cholesterol, heart disease

• Diabetes

• Sickle cell anemia

• Previous stroke or TIA, history of aneurysms

• Atrial fibrillation

• Recent travel, surgery or pregnancy

• Unhealthy diet (high in trans/saturated fats and cholesterol)

• Lack of exercise

• Obesity

• Alcohol and tobacco use

• Stress

• Depression

Statistics

• #5 cause of death in the US (~129,000 people a year)

o Someone in the U.S. has a stroke about once every 40 seconds, while someone dies from a stroke about once every four minutes

• Men are more likely than women to have a stroke, but women are more likely to die from one

o Pregnancy and use of birth control pills pose special risks for women

• 30% increase of ischemic strokes in adolescents and young adults (ages 15-34) from 1995 to 2008

o Correlated with increase in risk factors like smoking and drinking

Patient Assessment

• “Time is Brain”

• Signs/Symptoms

• History

• Physical Examo Vitals

o CPSS

• Treatment

“Time is Brain”

• The most effective stroke treatments are only available if the stroke is recognized and diagnosed within 3 hours of the first symptoms, so it is paramount that they be transported with ALS asap

Signs and Symptoms of a Stroke

• Sudden numbness or weakness in the face, arms, or legs, especially on one side of the body

• Sudden confusion, trouble speaking, or difficulty understanding speech

• Sudden trouble seeing in one or both eyes

• Sudden trouble walking, dizziness, loss of balance, or lack of coordination

• Sudden severe headache with no known cause

Patient History• Baseline status – what are they normally like

• Time last seen at baseline

• Past medical history (hypertension, diabetes, atrial fibrillation, TIA/previous stroke, etc.)

• Medications (particularly blood thinners like aspirin, clopidogrel, warfarin, Pradaxa)

oPradaxa has caused a significant number of deaths due to uncontrollable hemorrhaging, so the FDA has approved Praxbind as a reversal agent of Pradaxa

•http://www.pogo.org/blog/2015/10/fda-approves-necessary-antidote-for-pradaxa.html?referrer=https://www.google.com/

• Social history (alcohol, smoking, etc.)

• Head trauma

Physical Exam

• Level of consciousnesso (+)AMS

• Vitals o high BP

o irregular heart beat

• Neurological exam o CPSS (next page)

• Blood glucometer to eliminate possible diabetic emergency or hypoglycemiao As of right now, we don’t have the ability to do this, but it is very important and all

transporting EMS agencies in the area can do it.

Treatment

• Low-flow oxygen

• Vitals every 5 minutes

• Have them sit if they’re not sitting already

• Call Med Control if unsure

• Wait for ambulance, upgrade priority if possible

• Keep them as calm as possible

References• http://onlinelibrary.wiley.com/doi/10.1002/ana.22539/full

• http://www.cdc.gov/stroke/index.htm

• http://www.ems1.com/patient-assessment/articles/91183048-Tips-for-assessing-and-treating-stroke-victims/

• http://www.stroke.org/understand-stroke/what-stroke/hemorrhagic-stroke

• http://www.smchealth.org/sites/main/files/file-attachments/2010_ems_stroke_lecture_3_bhopale.pdf