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Stroke Response
EMERGENCY
TIME IS BRAIN: Every minute without treatment = 2 million brain cells lost.
Treatment window: 3-4.5 hours for clot-busting drugs. Sooner = better outcome.
FAST Assessment
F - FACE
Ask them to smile or show teeth.
Normal: Both sides move equally
Stroke: One side droops or doesn't move
A - ARMS
Ask them to close eyes, hold both arms out in front.
Normal: Both arms stay up
Stroke: One arm drifts down or can't lift
S - SPEECH
Ask them to repeat: "The sky is blue" or "You can't teach an old dog new tricks."
Normal: Clear, correct words
Stroke: Slurred, garbled, wrong words, or can't speak
T - TIME
If ANY of the above are abnormal:
Call 911 IMMEDIATELY
Note the time symptoms started - this determines treatment options.
Other Stroke Signs
Common Symptoms
- Sudden numbness: Face, arm, or leg - especially one side
- Sudden confusion: Trouble understanding, disorientation
- Sudden vision problems: Blurred, double vision, vision loss in one or both eyes
- Sudden dizziness: Loss of balance, trouble walking, coordination problems
- Sudden severe headache: "Worst headache of my life" - no known cause
- Sudden trouble swallowing
Less Common Signs
- Sudden behavioral change, agitation
- Sudden nausea/vomiting (different from GI illness)
- Brief loss of consciousness or fainting
- Sudden hiccups with other symptoms (unusual but documented)
Stroke Types
Ischemic Stroke (87% of strokes)
Blood clot blocks artery to brain. Most common type.
Treatment: Clot-busting drugs (tPA) if within 3-4.5 hours. Mechanical clot removal (thrombectomy) up to 24 hours for some patients.
Hemorrhagic Stroke (13% of strokes)
Blood vessel ruptures, bleeds into brain. More deadly, different treatment.
Causes: High blood pressure, aneurysm, arteriovenous malformation (AVM), head trauma, blood thinners.
Treatment: Control bleeding, reduce brain pressure. Surgery may be needed. DO NOT give clot-busting drugs - makes bleeding worse.
TIA (Transient Ischemic Attack) - "Mini Stroke"
Stroke symptoms that resolve within 24 hours (usually minutes to an hour). WARNING SIGN - 10-15% of people who have TIA will have full stroke within 3 months, highest risk in first 48 hours.
Action: Even if symptoms resolve, seek medical care immediately. Don't wait to see if it happens again.
Immediate Actions
What To Do
- Call 911 immediately - Don't wait to see if symptoms pass. Time matters.
- Note time symptoms started - Most critical information for treatment. If you didn't witness onset, note last time person was seen normal.
- Keep person comfortable: Have them lie down on their side (recovery position) if nauseous or sleepy.
- Don't give food, water, or medication: Swallowing may be impaired. Aspiration risk.
- Unlock door: So EMS can enter quickly.
- Stay calm, reassure person: Anxiety increases blood pressure.
- Gather information: Medications, medical history, allergies for EMS.
What NOT To Do
- Don't give aspirin: You don't know if it's ischemic or hemorrhagic. Aspirin makes hemorrhagic worse. Hospital will determine stroke type.
- Don't let person sleep: Common stroke response but delays treatment.
- Don't drive yourself: Ambulance can start treatment, call ahead to hospital, bypass smaller facilities.
- Don't wait for symptoms to improve: They won't without treatment.
- Don't give food or water: Swallowing difficulty = aspiration risk.
While Waiting for EMS
Monitor and Prepare
- Check breathing: If stops, begin CPR
- Keep airway clear: If vomiting, turn on side
- Loosen tight clothing: Collars, belts
- Don't leave them alone: Condition can worsen rapidly
- Write down medications: Especially blood thinners (Coumadin, warfarin, Plavix, Xarelto, Eliquis)
- Clear path to door: Move furniture if needed
- Turn on outside lights: If night
Risk Factors
Modifiable (Can Change)
- High blood pressure: #1 risk factor. Control with medication, diet, exercise.
- Smoking: Doubles stroke risk. Quitting reduces risk within years.
- Diabetes: Increases risk 2x. Control blood sugar.
- Atrial fibrillation: Irregular heartbeat causes clots. Blood thinners prevent strokes.
- High cholesterol: Diet, exercise, medication.
- Obesity: Contributes to other risk factors.
- Physical inactivity: Regular exercise reduces risk.
- Excessive alcohol: Limit to 1-2 drinks/day maximum.
- Drug use: Cocaine, amphetamines increase risk dramatically.
Non-Modifiable (Cannot Change)
- Age: Risk doubles each decade after 55
- Gender: Women have more strokes (live longer), men have strokes younger
- Race: Higher risk in African Americans, Hispanic Americans
- Family history: Genetic factors
- Previous stroke or TIA: Increases future risk
Recovery
Post-Stroke
Recovery varies widely. Brain can rewire (neuroplasticity). Most recovery in first 3-6 months but continues for years.
- Physical therapy: Regain movement, strength
- Occupational therapy: Daily living skills
- Speech therapy: Communication, swallowing
- Prevention: Address risk factors to prevent recurrence
25% of stroke survivors will have another stroke. Prevention is critical.
REMEMBER:
F - Face drooping?
A - Arm weakness?
S - Speech difficulty?
T - Time to call 911
Note symptom start time. Don't give aspirin. Don't wait.
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