Treatment FAQ

question help what treatment is the most critical factor in the emergency care of a stroke patient?

by Dr. Manuela Yost DDS Published 3 years ago Updated 2 years ago
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Medication

Emergency treatment for stroke depends on whether you're having an ischemic stroke or a stroke that involves bleeding into the brain (hemorrhagic). To treat an ischemic stroke, doctors must quickly restore blood flow to your brain. This may be done with: Emergency IV medication.

Procedures

Doctors will try to find the cause of your stroke to determine the most appropriate treatment. If you're seeking your doctor's advice during a scheduled appointment, your doctor will evaluate your risk factors for stroke and heart disease.

Therapy

Recognizing the key role of emergency medical technicians (EMTs) and paramedics in stroke care was a priority for the Georgia Coverdell Acute Stroke Registry (GCASR). “The first person who touches the stroke patient is a part of the health care team, and that’s EMS.

Nutrition

A stroke can be a serious and frightening medical emergency that has a huge impact on both stroke patients and their families. Strokes are life-changing events, but many stroke patients and those who care for them don’t know much about the nature of strokes and the recovery process.

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How is a stroke treated in the emergency room?

How does a doctor determine the most appropriate treatment for stroke?

What is the role of emergency medical technicians in stroke care?

Is a stroke considered a medical emergency?

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What is the most important treatment for a stroke patient?

For an ischemic stroke—a stroke caused by a blood clot blocking a vessel that supplies blood to the brain—treatment involves either busting the clot or physically removing it. For many patients, the blood clot can be treated with clot-dissolving medications like tissue plasminogen activator (tPA) or tenecteplase (TNK).

What are 3 treatments for a stroke?

Stroke treatmentClot-breaking drugs. Thrombolytic drugs can break up blood clots in your brain's arteries, which will stop the stroke and reduce damage to the brain. ... Mechanical thrombectomy.Stents. ... Surgery. ... Medications. ... Coiling. ... Clamping. ... Surgery.

What is the most important factor associated with a stroke?

Having an irregular heartbeat (atrial fibrillation) is the most powerful and treatable heart risk factor of stroke.

What is the first aid treatment for stroke?

If they're not breathing, perform CPR. If they're having difficulty breathing, loosen any constrictive clothing, such as a tie or scarf. Talk in a calm, reassuring manner. Cover them with a blanket to keep them warm.

What is the best treatment to give a possible stroke patient who is not in the hospital?

A clot-busting medication called tPA, or tissue plasminogen activator, can be given to someone if they're having a stroke, potentially reversing or stopping symptoms from developing.

What is the treatment for blood clot in brain?

Thrombolysis – "clot buster" medicine Ischaemic strokes can often be treated using injections of a medicine called alteplase, which dissolves blood clots and restores blood flow to the brain. This use of "clot-busting" medicine is known as thrombolysis.

Why is stroke a medical emergency?

Contents. A stroke is a serious life-threatening medical condition that happens when the blood supply to part of the brain is cut off. Strokes are a medical emergency and urgent treatment is essential. The sooner a person receives treatment for a stroke, the less damage is likely to happen.

Which risk factor for stroke is manageable?

High Blood Pressure is the No. 1 Controllable Risk Factor for Stroke.

What are complications of stroke?

Stroke Types and Their Impact on ComplicationsBlood clots (deep vein thrombosis or pulmonary embolism)Brain swelling.Seizures.Memory loss.Vision and hearing problems.Muscle weakness.Bed sores.Depression.More items...

What does a nurse do for a stroke patient?

Nurses working in acute stroke services have a wide-ranging role that includes assessment, identification and monitoring, as well as rehabilitation, psychological support and end of life care.

Why is first aid important?

It gives you tools to prevent the situation from becoming worse. In some situations if a patient doesn't receive basic first aid care immediately their situation will deteriorate – often rapidly. By being able to provide basic care you can stabilize a patient until emergency medical services arrives.

What is the first aid treatment for high blood pressure?

Sit down and focus on your breathing. Take a few deep breaths and hold them for a few seconds before releasing. Take your blood pressure medication if your doctor has prescribed something for you. A cup of hibiscus or chamomile tea can also help you feel calmer, it is a good idea to stock up on these teabags.

What is a cerebral angiogram?

Cerebral angiogram. Cerebral angiogram. A cerebral angiogram showing a carotid aneurysm associated with stroke. A physical exam. Your doctor will do a number of tests you're familiar with, such as listening to your heart and checking your blood pressure. You'll also have a neurological exam to see how a potential stroke is affecting your nervous ...

What is the most common type of stroke?

The most common type of stroke – ischemic – is when a blood vessel is blocked and not enough blood flows to the brain. "Stroke can happen to anyone, anywhere, anytime.".

How to deliver tpa to brain?

Medications delivered directly to the brain. Doctors insert a long, thin tube (catheter) through an artery in your groin and thread it to your brain to deliver tPA directly where the stroke is happening. The time window for this treatment is somewhat longer than for injected tPA, but is still limited.

How does TPA help with stroke?

This drug restores blood flow by dissolving the blood clot causing your stroke. By quickly removing the cause of the stroke, it may help people recover more fully from a stroke. Your doctor will consider certain risks, such as potential bleeding in the brain, to determine if tPA is appropriate for you.

How to reduce risk of stroke?

To decrease your risk of having another stroke or transient ischemic attack, your doctor may recommend a procedure to open up an artery that's narrowed by plaque. Options vary depending on your situation, but include:

How to evaluate stroke care?

One way to evaluate the care of patients diagnosed with stroke is to look at the percentage of patients receiving the timely and effective care measures that are appropriate. The goal is 100 percent.

What is a CT scan?

A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show bleeding in the brain, an ischemic stroke, a tumor or other conditions. Doctors may inject a dye into your bloodstream to view your blood vessels in your neck and brain in greater detail (computerized tomography angiography).

What is the caregiver's advice after a stroke?

A stroke can be a serious and frightening medical emergency that has a huge impact on both stroke patients and their families. Strokes are life-changing events, but many stroke patients and those who care for them don’t know much about the nature of strokes and the recovery process.

How does a stroke affect the brain?

Strokes have a big impact on the brain and nervous system, and parts of the brain can experience cell damage. Fortunately, the damage is sometimes temporary, and even in cases where the stroke permanently kills brain cells, healthy areas of the brain have been known to take over for the damaged portions.

How many times more likely are you to have a stroke at 65?

According to a study conducted by Boston University, children of individuals who had strokes before age 65 were two times more likely to have a stroke at some point in their lives and four times more likely of having a stroke by age 65, when compared to study participants whose parents had not experienced a stroke.

What to do if someone has a stroke?

If a friend or loved one is exhibiting any of these symptoms, call 911 and get to a hospital. Don’t hesitate! Even if only some of the symptoms are present, it’s better to be safe than sorry. Be sure to take note of the time that the stroke symptoms started to show, even if they end up going away.

What is the sixth leading cause of death for children?

This includes teenagers, children, and even infants. In fact, stroke is the sixth leading cause of death for children, although as children get older, their odds of suffering from a stroke decrease (the greatest chance of having a stroke is during a baby’s first year).

How to treat spastic muscle after stroke?

Spasticity—the stiffness or tightness of the muscles that often occurs after a stroke—can be treated through therapy or surgery, depending on the severity of the problem. Minor spasticity can be controlled with oral or injectable medications and stretching, while other cases may require orthoses (braces) or casting.

What are the side effects of a stroke?

One of the most common side effects of a stroke is trouble with speech. Because a stroke can damage the part of the brain that deals with language, many stroke patients are left with difficulty speaking or comprehending speech.

What is blood thinner?

Blood-thinning drugs are given to lower the risk of blood clots forming--and thus prevent heart attack, ischemic stroke, blood clots to the lungs, or blood clots in the legs. Among the medications that are prescribed are aspirin, clopidogrel (Plavix ®), ticlopidine (Ticlid ®), aspirin and dipyridamole (Aggrenox ®), and warfarin (Coumadin ®). The selection of medications is based on several factors including the patient's age and presentation, the likely cause of stroke, overall health, other medical disorders, and previous treatment. In addition, measures to treat local areas of artery disease can include surgery (carotid endarterectomy) and endovascular treatment (angioplasty and stenting). New medical and local interventions to prevent stroke are being evaluated in clinical studies.

What causes blood clots to go to the brain?

In addition, persons with structural diseases of the heart, such as an abnormal heart valve or recent heart attack, or an irregular heartbeat (atrial fibrillation) are at high risk for blood clots to go to the brain (cerebral embolism). Less common causes of stroke include injury to an artery (dissection), inflammation of the artery, or disorders of blood clotting.

What causes a stroke in the brain?

Less common causes of stroke include injury to an artery (dissection), inflammation of the artery, or disorders of blood clotting. Approximately 20 percent of strokes involve bleeding into or around the brain. In general, patients with brain hemorrhages are very seriously ill.

What are the factors that increase the risk of stroke?

Other conditions that increase the risk of stroke include alcohol or drug abuse. Measures to control these conditions can lower the risk of stroke. These measures include diet, changes in lifestyle, and medications. Persons with these conditions should discuss potential treatment options with their physicians.

Why is stroke a public health problem in Iowa?

The leading risk factor for stroke is advancing age. Thus, stroke is an important public health problem for Iowa because of its large elderly population. With lengthening of life expectancy and advancing age of Americans, the frequency of stroke will increase dramatically ...

What are the measures to treat artery disease?

In addition, measures to treat local areas of artery disease can include surgery (carotid endarterectomy) and endovascular treatment (angioplasty and stenting). New medical and local interventions to prevent stroke are being evaluated in clinical studies.

Why do people fear stroke?

Stroke is a leading cause of long-term disability, and many persons fear stroke not because it might lead to death but that independence will be lost. Stroke is second to dementia as a reason for long-term institutionalized care, and the effects of stroke can potentiate the effects of other diseases such as Alzheimer's disease.

What is the condition that can be confused with a patient experiencing a stroke?

Maintaining an adequate airway. A patient suffering from what other disorder can sometimes be confused with a patient experiencing a stroke. Hypoglycemia. A patient informs the EMT of an excruciating​ right-sided headache, nasal​ congestion, and excessive right eye watering.

How many ml of solution is given over a fraction of an hour?

50-250 mL in solution given over a fraction of an hour

Is there a high likelihood of an ischemic stroke?

There is a high likelihood of an ischemic stroke

What is the best treatment for ischemic stroke?

In addition, specific stroke therapies place the patient at higher risk of complication in the immediate post intervention period. These include intravenous tissue plasminogen activator (tPA), which is used in 3.4–5.2% of ischemic strokes [2], and endovascular clot retrieval, which is increasing in use since the publication of multiple randomized trials demonstrating its efficacy [3–7]. These patients benefit from the close neurologic and hemodynamic monitoring provided in the ICU to minimize the risk of secondary injury, as discussed below. Separately, there is a subset of large hemispheric stroke patients who require close neuromonitoring in the ICU, in particular to watch for and intervene upon the development of malignant edema and hemorrhagic transformation.

What is the limiting factor for extubation in stroke patients?

Acute stroke patients typically require little in the way of mechanical ventilatory support, such that the limiting factor in extubation is oropharyngeal control and the timing and pace of neurologic recovery. In those patients with large hemispheric (middle cerebral artery or MCA) stroke, a GCS ≥ 8 was associated with successful extubation [14]. Similar results were seen in posterior fossa stroke, where GCS > 6 at the time of intubation combined mechanical ventilation time of less than 7 days were associated with success [15]. It is likely that more fined-grained examination can provide better predictive value, as evidenced by a study of a mixed group of neuro ICU patients (including ischemic stroke), showing that the ability to follow four separate commands was predictive of extubation success, more so than GCS alone [16].

What blood pressure is required for TPA?

To be eligible for treatment with intravenous tissue plasminogen activator (tPA), patients must have a blood pressure less than 185/110 [27, 28]. This can be achieved by treatment with intravenous antihypertensives within the acute period. After administration of tPA, patients should be maintained below 180/105 to minimize the risk of hemorrhagic conversion. A similar approach is taken with patients following endovascular thrombectomy, many of whom will have also received IV tPA. There may be a role for further blood pressure decrease after clot retrieval, an an effort to limited potential reperfusion hyperemia, however this has not been systematically examined.

How often should you taper hyperosmolar therapy?

In those that do not, we monitor for signs of clinical and radiographic improvement and then begin to taper treatment by spacing doses of hyperosmolar agents to every 8 or 12 hours before tapering off.

What happens to the brain after a stroke?

Ischemic brain injury following stroke leads to an initial cytotoxic injury that can lead to the influx of water and development of tissue edema. While there is evidence that such swelling can impact outcome even in small infarcts [29], most concerning is the malignant edema that can occur following large hemispheric infarction. While this complication affects only an estimated 2–8% of ischemic stroke admissions annually, the mortality is high at 40–80% [30].

How many strokes are there in the US?

Stroke is the fifth leading cause of death and a leading cause of disability in the United States, with nearly 800,000 Americans experiencing new or recurrent stroke annually [1]. Globally, stroke is the second leading cause of death, with 11.6 million incident ischemic strokes each year. While these numbers remain high, there has in fact been much progress in reducing mortality from stroke. This has been due in part to a focus on providing care in specialized stroke units. Less widely understood is the role of intensive care in stroke management, which is the focus of this review.

How to calculate osmolal gap?

Serum osmolarity, BUN, sodium and glucose are monitored to allow for calculation of the osmolal gap according to the formula: Osm gap = Measured osm – (1.86(Na + K [mmol/L]) + glucose[mg/dL]/18 + BUN[mg/dL]/2.8). Osm gap > 10 suggests that mannitol is no longer being adequately cleared, and therefore additional doses should be held until the osmolal gap has closed to < 10.

Why is EMS transport important?

Improving the quality of care for stroke patients during EMS transport is crucial to improving health outcomes for patients with this time-sensitive condition. Most strokes are caused by a clot in the brain, which blocks blood flow and causes brain cells to die.

What is an EMS?

Emergency medical services (EMS) professionals, such as paramedics and emergency technicians, are key to a stroke patient’s treatment. Learn how the Coverdell program supports EMS through training and resources.

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Diagnosis

Treatment

Treatment Outcomes

Clinical Trials

Medically reviewed by
Dr. Karthikeya T M
Your provider will work with you to develop a care plan that may include one or more of these treatment options.
Treatment is based on the type of stroke. For ischemic stroke or transient ischemic attack, medication or surgery or both can be recommended and for hemorrhagic stroke, surgery is recommended.
Medication

Clot dissolver: To dissolve clots and reopen arteries.

Plasminogen activator (tPA)


Anticoagulants: Has the effect of retarding or inhibiting the coagulation of blood.

Aspirin . Clopidogrel

Procedures

Catheter mediated intra-arterial thrombolysis: To attain reperfusion in case of ischemic stroke or transient ischemic attack.

Angioplasty and stent placement: Widens the blocked artery and a stent is placed.

Aneurysm clipping: To treat a balloon-like bulge of an artery wall known as an aneurysm.

Coil embolization: To treat aneurysm that may have caused hemorrhagic stroke.

Carotid endarterectomy: To correct stenosis (narrowing) in the common carotid artery or internal carotid artery.

AVM removal: Carried out in case of hemorrhagic stroke.

Therapy

Rehabilitation:The rehabilitation is advised to start as early as possible upon recovery. Rehabilitation program will be decided as per the necessity and usually focuses on speech therapy; cognitive therapy; sensory and motor skills; and physical therapy.

Nutrition

Foods to eat:

  • Fruits and vegetables: eat plenty of fruit and vegetables; between 5-7 servings per day
  • Whole grain breads and cereals containing fiber and vitamins: They may reduce the risk of stroke
  • Lean protein: Limiting the amount of cholesterol is another important step in reducing the risk of another stroke
  • Choose low-fat meats or other protein
  • Limit salt: Eating too much salt/sodium may cause you to retain water and raise your blood pressure

Foods to avoid:

  • Heavy cholesterol foods
  • foods rich in salt and sugar
  • Alcohol

Specialist to consult

Neurologist
Specializes in treating diseases of the nervous system, which includes the brain, the spinal cord, and the nerves.
Neuroradiologist
Specializes in the use of radioactive substances, x-rays and scanning devices for the diagnosis and treatment of diseases of the nervous system.
Occupational therapist
A healthcare professional who helps in development, recovery, or management of everyday activities, or occupations.
Speech therapist
A health professional who specializes in evaluating and treating voice, speech, language, or swallowing disorders.
Physical therapist
A health professional who helps patients reduce pain and improve or restore mobility.

Coping and Support

Preparing For Your Appointment

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