Stroke (Cerebrovascular Accident)

Understanding Stroke

  • Stroke: Also known as a cerebrovascular accident (CVA), it occurs when blood flow to the brain is blocked (ischemic stroke) or a blood vessel bursts causing hemorrhage (hemorrhagic stroke).

Types of Stroke

Ischemic Stroke

  • Occurs when a clot blocks blood flow in cerebral arteries.

Hemorrhagic Stroke

  • Involves the bursting of a blood vessel, leading to blood leakage into the brain.

Importance of Quick Diagnosis

  • Diagnosis: Patients require immediate imaging (CT scan) to determine stroke type, which affects treatment decisions (medication vs. surgery).

Risk Factors

  • Common Risk Factors:

    • Smoking

    • High blood pressure

    • High cholesterol

    • Diabetes

  • Atrial Fibrillation (AFib): Increases stroke risk, especially in individuals with a history of prior strokes or blood clots.

Signs and Symptoms

Monitoring Vitals

  • High blood pressure is often seen in stroke patients.

BE FAST Mnemonic

  1. Balance: Check for loss of balance; may be a reason for seeking help.

  2. Eyes: Look for vision loss or blurry vision. Check for nystagmus using a penlight.

  3. Facial Droop: One side of the face may droop down; assess symmetry.

  4. Arm Drift: Have the patient close their eyes and hold arms up. One arm dropping indicates weakness.

  5. Speech: Check for slurred speech or confusion; clear or coherent speech is necessary.

  6. Time: Determine when the patient was last seen normal.

Treatment Considerations

tPA Administration

  • tPA (tissue Plasminogen Activator)

    • Used to treat ischemic strokes within a 3-4.5 hour window.

    • Not used for hemorrhagic strokes as it can worsen the condition.

Initial Management Steps

  1. Administer oxygen to keep SpO2 above 94%.

  2. Check blood glucose; hypoglycemia can mimic stroke symptoms.

  3. If blood glucose is normal and oxygen levels are corrected, call a stroke alert for rapid transport to a stroke center.

Transport Protocol

  • Recognize stroke symptoms early and prioritize quick transport to a hospital with stroke care capabilities for possible intervention (e.g., tPA or surgery).

  • Differences in response between ALS (Advanced Life Support) and BLS (Basic Life Support) primarily include capabilities like IV access and monitoring.