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Stroke (optional)

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5 minutes
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Speaker 2: Headache. Let's see what's on that other thing, here. Help! Somebody... it hurts... something's wrong with me, please somebody call... help me help me please. Speaker 1: Hey Carol, I heard you yell out for some help? So listen, can you tell me what's going on? Speaker 2: I don't feel good. Speaker 1: You don't feel good? Speaker 2: No, my head hurts, my neck. I just don't feel good. Speaker 1: I see your remote down here. Did you drop it? Speaker 2: Yeah, I was trying to change the channel. Speaker 1: Can you do something for me? Can you smile at me a second? A big smile? Okay, good. Listen, I am gonna hold your arms up here a moment, I don't want you to let them drop. Just hold them both even. Okay, good you can rest your arms again. Can you say, I love my husband more than anybody? Speaker 2: I love- Speaker 1: Okay good, that's good. What time do you think this started? Was it, can you, was it recently, was it long time ago? Just nod your head up or down if it was recently? Speaker 2: Yeah Speaker 1: Okay, Carol, I don't wanna alarm you, but I think you're showing enough symptoms that we should suspect something serious, and we should call for help, and get an ambulance on the way. The hospital can certainly help you, but you're having enough signs and symptoms that I am concerned that it could be a stroke, not that I am for sure, but I know that at the hospital they can take better care of you there than here at your home. Listen, I think we're gonna give the ambulance a call, and then if there is nothing you'll buy some peace of mind okay. Okay, okay, and I am not gonna leave you either. I am gonna stay right here, so don't worry about that. Now, let's take a closer look at what a stroke is, how the signs and symptoms help indicates to us that its an emergency, and then what to do in case we recognize those signs and symptoms. So, a stroke has been said to be like an heart attack, but in the brain, and the reason why that analogy works is because we know more about what causes strokes, and most of the time in many cases, the reason they're having a stroke is very similar to the reasons we're having a heart attack. Something has dislodged and blocked a vessel in the brain, and is now starving that brain tissue of oxygenated blood which is now begin to show affects neurologically in the patient's body. Now, it can also be caused from a breakage or a bursting of a blood vessel. A hemorrhagic stroke is normally caused from an aneurysm, and is treated differently that we treat strokes from a blockage of a blood clot, or a fatty clot. Let's talk about the fast. The acronym fast is a way for us to be able to check systematically if the patient is showing enough signs and symptoms that we should be concerned that they might be suffering from a stroke, and then activate emergency medical services. So let's break down those for a moment. F stands for facial drop. One of the ways to see this when its maybe not real drastic is to have the patient smile at you. When they smile, does one corner of the mouth hang lower than the other? Then, we move to A which stands for arm. Arm is when we raise both patient's arms in front of them, and the same side that they have facial drop, the arm lists and kind of floats away from the other arm. They're not able to hold the arm up like they can the first arm that's not affected. Then, we talk about S, S stands for Slurred speech. To get them to say something to you, because they're probably be very panicked at this point. I like to give them a humorous sentence to say back to me, or maybe something about themselves, or their date of birth, if they seem to be slurring their speech, then that falls into that category of S for stroke symptoms, and then lastly T. T stands for time. What time did the symptoms begin? The reason that this is important, and why we wanna write this down is to make sure we tell the responding medical services is because, the time of the essence. If we're going to try to recirculate the oxygenated blood back to their brain tissue, and help this patient recover with his little long lasting damage as possible. So, if a patient starts to show that signs and symptoms under the fast acronym, we know that it is important for us to reassure the patient that we're gonna take good care of them, we're not going to dessert them, but we're going to activate 911 or the emergency medical services, so that we can expedite the treatment of this patient, and help them regain as much quality of life as possible.

In this lesson, we're going to go over what a stroke is, what the signs and symptoms are that will indicate to you that there's an emergency, and what to do if you suspect a stroke. And we'll even teach you an easy-to-remember acronym to make your stroke assessment a little easier.

What is a Stroke?

A stroke, also called a cerebrovascular accident (CVA), is a disruption of blood flow to a part of the brain, which may cause permanent damage to brain tissue if not appropriately treated in a timely manner.

There's a common analogy that works well to describe what a stroke is – a stroke is like a heart attack in the brain. This analogy works because what typically causes a stroke is usually what causes a heart attack – a blocked blood vessel – only in the brain rather than the heart.

When a blood vessel blockage occurs, it starves the brain of oxygenated blood, which will quickly result in neurological effects in the patient's body.

A stroke can also be caused by a bursting of a blood vessel rather than a blockage. In these cases, the condition is known as a hemorrhagic stroke, and is normally the result of an aneurism. The important takeaway is that hemorrhagic stroke is treated differently than strokes that occur from blood vessel blockage.

What are the Signs and Symptoms of a Stroke?

Using the acronym FAST, you'll be able to navigate quickly through the list of stroke symptoms and systematically check them off as you go. And ultimately, if the patient is having a stroke, call 911 and activate EMS.

F – Facial Droop

If you're having a difficult time assessing the patient for facial droop, ask them to smile at you. If the droop isn't initially very pronounced, it will be when the patient tries to smile.

Does the smile look normal? Or is one corner of the mouth lower than the other?

A – Arm

Raise both of the patient's arms out in front of them and ask the patient to hold that position. Does one arm fall lower than the other? Or do they both remain in the position you left them?

If one arm does begin to fall, as the patient cannot hold it up, it will likely be the arm on the same side of the body as the facial droop.

S – Slurred Speech

During medical emergencies, patients are naturally panicked, and it can affect their speech. To better assess for this stroke sign, ask them a question – like what their birth date is – or to repeat a certain phrase, like I love blueberries.

If the patient answers with slurred speech, you can check another item off your FAST checklist.

T – Time

Time is of the essence when it comes to treating stroke victims. But it's also important to know what time symptoms began in each victim, as this will matter when healthcare professionals begin trying to recirculate oxygenated blood back into the brain's tissue.

Your quick actions and attention to detail will go a long way to helping the patient recover with as little long-lasting damage as possible.

What to do if You Suspect a Patient is Having a Stroke

If you haven't already called 911 and activated EMS, do so immediately. Expediting treatment is key to the patient regaining as much quality of life as they can.

While waiting for EMS to arrive, reassure the patient. Tell them you're not going anywhere and that you'll take good care of them. And make them as comfortable as possible while you wait.

A Word About the Signs and Symptoms of Stroke

Other than the stroke alert criteria in FAST that you should be looking for, there are a few other signs and symptoms of stroke that may help you assess the patient better.

  • Loss of vision or disturbed vision in one or both eyes; the pupils may also be of unequal size
  • Sudden severe headache; you may hear the patient describe the pain as the worst headache ever
  • Confusion, dizziness, agitation, loss of consciousness, or other severe altered mental states
  • Loss of balance or coordination, trouble walking, or ringing in the ears
  • Incontinence

Pro Tip #1: it's important to understand the difference between a full-blown stroke and a TIA (Transient Ischemic Attack), sometimes called a mini-stroke. The latter is caused by reduced blood flow to a part of the brain, but unlike a stroke, the signs and symptoms disappear within a few minutes or hours of onset.

With a TIA, after a short time, blood flows again and the symptoms go away. With a stroke, the blood flow stays blocked, and the brain is more likely to suffer permanent damage.