Strokes Flashcards
Stroke
Occurs when blood flow is either cut off or reduced, depriving the brain of blood and oxygen
Ischemic stroke
Makes up 87% of strokes
Caused by a blockage in an artery stopping normal blood and oxygen flow to the brain.
Two types of ischemic strokes
Embolism
Thrombosis
Embolism
Type of ischemic stroke where a blood clot or plaque fragment from elsewhere
in the body gets lodged in the brain
Thrombosis
Type of ischemic stroke where a blood clot is formed in an artery that
provides blood to the brain
Blood clot
Mass of blood that forms when platelets, proteins and cells in the blood stick together to stop bleeding.
When the bleeding stops, the body breaks down and removed the blood clot
Blood clots not forming where they should, or too many blood clots, or abnormal blood clots are dangerous
Deep vein thrombosis (DVT)
Blood clot in deep vein usually in the lower leg, thigh, or pelvis. It can block a vein and cause damage to your leg.
Pulmonary Embolism (PE)
When the DVT clot breaks off and travels through the bloodstream to the lungs, and can damage the lungs and prevent organs from getting oxygen
Symptoms of blood clots
In the abdomen: Abdominal pain, nausea and vomiting
In an arm or leg: Sudden or gradual pain, swelling, tenderness, and warmth
In the lungs: Shortness of breath, pain with deep breathing, rapid breathing, and increased heart rate
In the brain: Trouble speaking, vision problems, seizures, weakness on one side of the body, and sudden severe headache
In the heart: Chest pain, sweating, shortness of breath, and pain in the left arm
Stroke from large vessel occlusion (LVO)
A more severe type of ischemic stroke occurs when a major artery in the brain is blocked.
Affects up to 46% of acute ischemic stroke
Caused by blockages in the internal carotid artery, middle cerebral artery, or basilar artery
Aneurysm
Occurs when part of an artery wall weakens, allowing it to abnormally balloon out or widen.
Can develop over many years and often have no symptom
When it ruptures, it can serve as a problem
Hemorrhagic stroke
Caused by breakage of blood vessel within the brain due to bleeding
13% of strokes caused by hemorrhage
Can be result of ruptured aneurysm
Aortic aneurysm
occurs in the main artery carrying blood from the heart to the body.
Cerebral aneurysm
occurs in an artery of the brain.
Two types of hemorrhagic stroke
Intracerebral hemorrhage
Subarachnoid hemorrhage
Intracerebral hemorrhage
Bleeding within the brain itself. This occurs when an artery in the brain bursts and floods the surrounding tissue with blood.
Subarachnoid hemorrhage
Occurs when a blood vessel bursts near the surface of the brain and blood
pours into the area outside of the brain, between the brain and the skull
Transient Ischemic Attack (TIA)
Caused by blockage, but is temporary and caused no permanent damage to the brain
Thromolysis
treatment that uses medications to break down blood clots in blood vessels and prevents new clots from forming
Used to treat heart attacks, PE, and stroke, and blood clots from DVT or PAS
Patient must receive thrombolysis, 0-3 hrs from symptom onset
Common Right-Sided Hemisphere Stroke symptoms
Dysarthria - Slurred speech
Weakness or numbness of the left side of face, arm, or leg
Right gaze preference
Systemic Hypoperfusion
A general decrease in blood supply, e.g., in shock)
Possible cause of stroke
Cryptogenic stroke
Stroke without obvious explanation
This happens in 30-40% of ischemic strokes
Left-Sided Hemisphere Stroke
- Speech problems: inability to get words out
- Comprehension problems
- Weakness of numbness of the right side of face, arm, or leg
- Left gaze preference
Brainstem stroke
- Nausea, vomiting, or vertigo
- Speech problems
- Swallowing problems
- Abnormal eye movements
- Decreased consciousness
- Crossed findings
CT scan
type of imaging that uses X-ray techniques to create detailed images of the body.
MRI scan
a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.
Can be used to identify anatomical position of tumor and tissue changes in stroke and epilepsy
Epilepsy
a chronic brain disease that causes recurring seizures, which are brief episodes of involuntary movement.
Contraindications to thrombolysis
- Severe recent or acute head trauma
- Recent intracranial/intraspinal surgery
- History of intracranial hemorrhage
- Recent GI malignancy or bleeding
- Blood clotting impairment
- Recent treatment with heparin
- Taking anticoagulant
- Known or suspected aortic arch dissection
Anticoagulants
Medicines that prevent or slow blood clotting
Used to lower risk of serious conditions such as strokes or heart attacks
Also known as blood thinners
Goal of stroke care
Minimizes brain injury and maximize the patient’s recovery
Stroke Chain of Survival links
1, Family member, friend or bystander recognizes stroke warning signs and rapidly calls 9-1-1
2, EMS rapidly arrives at scene and performs stroke assessment
3,. EMS rapidly notifies receiving hospital that patient will be arriving and EMS transports patient to the receiving hospital
- Hospital rapidly diagnoses and treats patient
Hospital levels of care
Acute Stroke Ready Hospital (ASRH)
Primary Stroke Center (PSC)
Thrombectomy-capable Stroke Center (TSC)
Comprehensive Stroke Center (CSC)
Acute Stroke Ready Hospital (ASRH)
- Stabilize the patient & provide IV thrombolysis if appropriate
- Transfer most patients to a CSC, TSC or PSC
- Frequently rely on telestroke for neurology expertise
Primary Stroke Center (PSC)
- Stabilize patient and provide IV thrombolysis if appropriate
- Either admit or transfer to a CSC
- Most common type of stroke center
Thrombectomy-capable Stroke Center (TSC)
- Meet all criteria of a PSC, including administering
IV thrombolysis if appropriate - Also provide mechanical thrombectomy (MT) for stroke
patients with large vessel occlusion (LVO)
Comprehensive Stroke Center (CSC)
- Have the capability to support all needed levels of care to all types of stroke patients, including hemorrhagic stroke:
o Provide IV thrombolysis and/or MT for ischemic stroke
patients when appropriate
o Full complement of stroke neurology, critical care, &
neurosurgical personnel & infrastructure
o Special interventions
o Highly technical procedures
EMS Assessment and Management
- Support ABCs: airway, breathing, circulation. Give oxygen if needed.
- Perform prehospital stroke assessment using a prehospital stroke screening tool.
- Establish time when patient was last normal; interview family members or
witnesses, if needed. - Identify if patient has significant pre-stroke disability.
- Identify current medications, especially anticoagulants, and obtain patient history including co-morbid conditions (e.g. recent surgery, procedures or stroke) that may impact treatment decisions.
- Provide advance notification to receiving hospital as soon as possible of potential stroke patient “CODE STROKE.”
- Check glucose level if possible.
Where to transport when a LVO Stroke is suspected:?
Comprehensive Stroke Center (CSC) or Thrombectomy-capable Stroke Center (TSC) within 45 minutes of max transport time
Cincinnati Prehospital Stroke Scale
Facial Droop: Have patient look up at you,
smile and show their teeth.
Normal: Left and right side of face move equally
Abnormal: One side of face does not move at all
Arm Drift: Have patient lift arms up and hold them out with eyes closed for 10 seconds.
Normal: Both left and right arm move together or not at all
Abnormal: One arm does not move equally with the other
Speech: Have patient say a simple sentence, i.e. “You can’t teach an old dog new trick
Normal: Patient uses correct words with no slurring
Abnormal: Patient has slurred speech, uses inappropriate words or cannot speak
If any 1 of these 3 signs is abnormal, the probability of stroke is 72%
If all 3 findings are present, the probability of acute stroke is >85%
