HOW TO RECOGNIZE A STROKE AND WHAT TO DO
A stoke occurs when a portion of the brain is deprived of oxygen-rich blood. This can occur by a clogged or blocked artery serving that portion of the brain or an artery can rupture. In the United States, about 700,000 people of all ages suffer a new or repeat stroke each year. About 158,000 of these people will die. This makes stroke the third leading cause of death in the United States.
It is the goal of healthcare providers, hospitals, and communities to develop systems to increase the efficiency and effectiveness of stroke care. The “7 D’s of Stroke Care” are detection, dispatch, delivery, door (arrival and urgent triage in the emergency department), data, decision, and drug administration. The “7D’s” highlight the major steps in diagnosis and treatment and the key points at which delays can occur.
What is the goal of stroke care? It is to minimize brain injury and maximize patient recovery. The American Heart Association and American Stroke Association developed a community-oriented “Stroke Chain of Survival” that links actions to be taken by patients, family members, and healthcare providers to maximize stroke recovery. The links are:
1. Rapid recognition and reaction to stroke warning signs
2. Rapid emergency medical services (EMS) dispatch
3. Rapid EMS system transport and hospital pre-notification
4. Rapid diagnosis and treatment in the hospital
It is essential to know how to recognize a stroke due to the fact that fibrinolytic treatment must be given within a few hours of the onset of symptoms. Unfortunately, stoke victims often deny or rationalize their symptoms and fail to seek medical attention immediately, delaying EMS access and treatment. Of course, this results in increased morbidity and mortality.
The signs and symptoms of a stroke may be subtle. They include sudden weakness or numbness of the face, arm, or leg, especially on one side of the body. There can be sudden confusion, trouble speaking or understanding. The patient may experience sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance or coordination, or sudden severe headache with no known cause.
To assess these signs, have the patient smile. The patient should be able to smile with both sides of their face moving equally. Stroke patients may have a facial droop; one side of the face does not move as well as the other side. Another assessment is the arm drift. When the patient closes their eyes and holds both arms straight out for 10 seconds, both arms should move the same. In the patient who is having a stroke, one arm does not move or one arm drifts down compared with the other. Having them grip your hands will allow you to see if their grip is equal on both hands or if they have a weak grip or no grip at all. Since difficulty speaking is one sign of a stroke, have the patient say something like “You can’t teach an old dog new tricks.” They should be able to say it without slurring. Stroke patients may slur the words or use the wrong words. Or they may not be able to speak at all.
If you suspect that a person is having a stroke, it is essential to call the local emergency medical services (EMS). They can assess a possible stroke and establish the time of the onset of symptoms, rapidly deliver the patient to a medical facility capable of providing acute stroke care, and provide pre-arrival notification to the receiving facility. En route to the facility, EMS can support cardiopulmonary function, monitor neurologic status, and if authorized by medical control, check blood glucose.
Until EMS arrives, the stroke patient needs to be continually monitored. If the patient is conscious, they can be kept comfortable lying down until EMS arrives. Since patients may drool, it is best to lay them on their side in the recovery position. In the unconscious patient, maintaining an open airway is critical. Putting the patient who is breathing in the recovery position will keep their airway open. If the patient is not breathing, CPR must be performed.
In the “Stroke Chain of Survival”, the first two links, recognition and calling EMS, involve the lay rescuer or bystander. Learning lifesaving skills such as CPR, recognizing a stroke, and calling EMS can greatly increase a stoke patient’s chance of survival.