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7k. Acute Stroke, Advanced Cardiac Life Support (ACLS) (2018)

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Published on Jun 30, 2017

The final lesson in chapter 7 covers Acute Stroke, its symptoms, and how care is provided. Stroke is defined as a condition in which normal blood flow to the brain is interrupted. The two variations of strokes are explained and the different ways in which care must be provided are discussed.

"Stroke is a condition in which normal blood flow to the brain is interrupted.

Strokes can occur in two variations: ischemic and hemorrhagic. In ischemic stroke, a clot lodges in one of the brain’s blood vessels, blocking blood flow through the blood vessel. In hemorrhagic stroke, a blood vessel in the brain ruptures, spilling blood into the brain tissue.

Ischemic stroke and hemorrhagic stroke account for 87 percent and 13 percent of the total incidents, respectively. In general, the symptoms of ischemic and hemorrhagic strokes are similar. However, the treatments are very different.

Clinical signs of stroke depend on the region of the brain affected by decreased or blocked blood flow. Signs and symptoms can include: weakness or numbness of the face, arm, or leg, difficulty walking, difficulty with balance, vision loss, slurred or absent speech, facial droop, headache, vomiting, and change in level of consciousness. Not all of these symptoms are present, and the exam findings depend on the cerebral artery affected.

To care for an individual with a stroke, proceed with this pathway.

Start with activating EMS.

Administer oxygen. Use 100 percent oxygen initially, and titrate as needed.

Perform fingerstick procedure. Check glucose. Hypoglycemia can mimic acute stroke.

Check history. Determine precise time of symptom onset from the individual and witnesses.

Examine the individual. Determine deficits, such as gross motor, gross sensory, and cranial nerves.

Institute seizure precautions.

Use a large gauge intravenously in antecubital fossa.

Notify the hospital. Take the individual to a stroke center if possible.

Individuals with ischemic stroke who are not candidates for fibrinolytic therapy should receive aspirin unless contraindicated by true allergy to aspirin. All individuals with confirmed stroke should be admitted to Neurologic Intensive Care Unit if available.

Before giving anything (such as medication or food) by mouth, you must perform a bedside swallow screening. All acute stroke individuals are considered NPO on admission.

Stroke treatment includes blood pressure monitoring and regulation per protocol, seizure precautions, frequent neurological checks, airway support as needed, physical/occupational/speech therapy evaluation, body temperature, and blood glucose monitoring. Individuals who received fibrinolytic therapy should be followed for signs of bleeding or hemorrhage.

Certain individuals (of age 18 to 79 years with mild to moderate stroke) may be able to receive tPA (or tissue plasminogen activator) up to 4.5 hours after symptom onset. Under certain circumstances, intra-arterial tPA is possible up to six hours after symptom onset. When the time of symptom onset is unknown, it is considered an automatic exclusion for tPA. If time of symptom onset is known, the National Institute of Neurological Disorders and Stroke (or NINDS) has established the time goals.

The NINDS established time goals advise the individual to have general assessment by expert and urgent CT scan without contrast within 10 minutes of arrival.

Within 25 minutes of arrival, you should perform a CT scan without contrast, perform a neurological assessment, and read CT scan within 45 minutes.

Within 60 minutes of arrival, you should evaluate criteria for using and administering fibrinolytic therapy, or “clot buster.” Fibrinolytic therapy may be used within three hours of symptom onset, or 4.5 hours in some cases.

Within 180 minutes of arrival, the individual should be admitted to the stroke unit. "

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