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A stroke occurs when the blood supply to part of the brain is interrupted or reduced, preventing the brain tissue from getting oxygen and nutrients. Lack of oxygen and nutrients can cause the brain cells to die within minutes of the stroke occurring, which is why prompt treatment is crucial to reverse and prevent further damage.
Close to one million people suffer from strokes in the United States per year, with about 1 in 4 people having had previous strokes. Strokes are the leading cause of serious long-term disability, with reduction in mobility in more than half of stroke survivors who are 65 years of age and older.
There are 3 main types of strokes:
1.Ischemic Stroke – when the artery that supplies the oxygen-rich blood to the brain becomes blocked. 87% of strokes are ischemic strokes.
2.Hemorrhagic Stroke – when an artery in the brain leaks blood or ruptures, putting too much pressure on the brain cells, thereby damaging them.
3.Transient Ischemic Attack (TIA) – these are some times referred to as “mini-stroke”. The blood flow to the brain is only blocked for a short amount of time. These types of strokes are considered warning signs for a future stroke and should be treated as a medical emergency.
Signs and Symptoms of a Stroke:
1.Sudden numbness or weakness in the face, arms or leg, especially on one side of the body
2.Sudden confusion, trouble speaking, or difficulty understanding speech
3.Sudden trouble seeing
4.Sudden trouble walking, dizziness, loss of balance, or lack of coordination
5.Sudden severe headache
Quick Diagnosis:
Acting F.A.S.T. is the key for quick identification and treatment.
F – Face: Ask the person to smile. Does one side of the face droop?
A – Arms: Ask the person to raise both arms. Does one arm drift downward?
S – Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange?
T – Time: If you see any of these signs, call 911 right away.
Noting the time that the stroke occurred is important for health care providers to implement the correct treatment because prompt treatment after a stroke is suspected is important to help reverse the blockage or bleed and prevent permanent neurological damage.
Focusing on the patient’s history to help determine if the stroke was caused by a clot or a hemorrhage is important in the treatment plan.
Performing prompt laboratory studies as well as brain imaging such as a CT or MRI can help look for evidence of clots in the arteries or bleeding.
Treatment:
If the stroke was caused due to a blockage, administration of intravenous alteplase (a clot buster) is the first line therapy. This treatment should be initiated within 4.5 hours of the symptom onset as the benefits of alteplase is time dependent. These patients should also be placed on other clot preventing medications such as Aspirin, as well as cholesterol lowering medications to reduce the risk of further clots forming.
If the stroke was caused by bleeding in the brain, the treatment would differ from that of an ischemic stroke since we would not want to provide the patient with medications that could cause more bleeding. Treatment includes controlling or stopping the bleeding by stopping all medications that cause bleeding such as blood thinners, and administering reversal agents. Treatment for hemorrhagic strokes are much more difficult because it is harder to control the bleeding, and these patients are at a much higher risk of neurological deterioration due to elevated intracranial pressure due to the bleeding.
Long Term Complications:
If the signs and symptoms of a stroke are not detected early enough, long term negative complications can occur.
These patients can suffer from:
- Impaired speech
- Weakness or paralysis
- Difficulty eating and swallowing
- Difficulty performing activities of daily living such as dressing, bathing, etc.
Therefore, early identification and treatment is so important to prevent these poor outcomes. Using the quick diagnosis of F.A.S.T can be used by anyone to assess for a stroke so that prompt medical care can be initiated to prevent the long-term complications of a stroke.
If you have a case involving the improper diagnosis and treatment of a stroke, contact Weiser Nurse Consulting. We can help review the case and identify possible breaches in standard of care.