Oct 11, 2014
5.48k likes | 13.54k Views
STROKE. Presence Regional EMS System September 2013. “Grandpa had a stroke”. Not too long ago this statement meant death or disastrous disability for patients and families. In the 21 st century medical science has progressed in the understanding of STROKE,
Share Presentation
- stroke care
- fast stroke assessment
- 3 hours 180 minutes
Presentation Transcript
STROKE Presence Regional EMS System September 2013
“Grandpa had a stroke” • Not too long ago this statement meant death or disastrous disability for patients and families. • In the 21st century medical science has progressed in the understanding of STROKE, prevention and treatment
How big is the problem of STROKE?
Magnitude of the Problem • 795,000 Americans annually suffer a STROKE • 25% die • #3 killer of Americans • 25% of women have strokes before age 65 • #1 cause of long term disability
Stroke in the US • One case of stroke every 45 seconds • Results in devastating disability • 16% institutionalized in nursing homes • 31% assistance with Activities of Daily Living (bathing, dressing eating) • 20% assistance with walking • 30% depressed • Annual cost of $68 billion
New Advancements • The FDA has approved the same clot busting drugs (tPA thrombolytic) used in heart attacks to be used in brain attacks – stroke. • For a variety of reasons, only 2% of stroke victims are treated with thrombolytic medication • Aggressive treatment begins with assessment and intervention at point of patient contact
Before STROKE can be managed • Learn more about what strokes are and how they happen.
A very selfish organ • The brain requires 20 % of the total blood pumped by the heart. • No storage in the brain for either fuel or oxygen • Requires constant supply of oxygen and glucose.
Blood Supply to the Brain • Carotid arteries – anterior neck • Large • Frequently congested with plaque • Can be cleaned out surgically • Vertebral arteries • Pass through cervical vertebrae • Well protected • Not accessible for surgical cleaning
Circle of Willis • Both blood supplies (carotid and vertebral) join on the under surface of the brain. • Fail-safe mechanism in case of a blockage somewhere in circulation • BUT some hard corners in circle where debris can get caught and site of most cerebral aneurysms
What can go wrong??? • Disruption of blood flow to the brain • Plaque – build up of cholesterol in interior of blood vessel • Foreign debris– blood clot bubble of fluid air • Broken vessel
Ischemic STROKE • Blockage of blood flow to brain • Progressive Thrombus -- growing • Plaque deposit – similar to process in heart with coronary artery disease • Cerebral Emboli --Clot from somewhere else -- floating debris • Blood clot • Air bubble • Bubble of amniotic fluid • Bone marrow from a fracture
Hemorrhagic STROKE • Aneurysm – weakened area in artery • Congenital • Younger population younger than 40 years • Complain of “worst headache in my life” • Spontaneous Hypertensive Bleed • Due to BP > 200/100 • Malformed Artery • 50% younger than 30 years
Transient Ischemic Attack • “One Free Spin” • Looks like a stroke but,symptoms improve in 1-24 hours • Temporary disruption of blood flow to the brain –Like Unstable Angina of the brain • Warning sign (15% of strokes have TIA first) • Mimicked by low blood sugar (> blood sugar signs and symptoms go away) • 1 in 20 patients will have a true stroke in 3 months
Can STROKES be prevented? • Modifiable risk factors • High BP • Cigarette smoking • Alcohol intake • Uncontrolled Heart disease • Atrial fibrillation (creates mini clots) • Uncontrolled Diabetes • Carotid congestion
High blood cholesterol • Sedentary lifestyle • Obesity • Seasons– spring and fall • Stress
Risk Factors Unable to Control • Age • Gender • more women than men • Race • African American high risk • Prior strokes • Heredity • Sickle Cell Disease • Causes clot formation and strokes even in children
Signs and Symptoms of STROKE • Hemorrhagic • Sudden and dramatic • Violent explosive headache • “worst headache of my life” • Visual disturbance • Flashing lights, aura • Nausea and vomiting • Neck and back pain • Due to blood in sub-arachnoid space • Sensitivity to light • Weakness on one side • Can present like a migraine headache
Signs and Symptoms of STROKE • Ischemic Stroke • Harder to detect • Weakness in one side • Facial drooping • Numbness and tingling • Language disturbance • Visual disturbance
Left Brain Stroke • Right side paralysis • Speech and language disturbance • Behavioral changes • Swallowing problems
Right Brain Damage • Left side paralysis • Spatial perception • Where your limbs are in relation to the room • Coordination problems • Perception • Recognition of familiar objects
Primary Stroke Care • 180 minute window of time • Time is tissue • The longer the brain is without oxygen and glucose the more brain cells die Goal is to restore blood flow as soon as possible • Treatment is a system beginning with early recognition and continuing through rehabilitation
Goals of Primary STROKE Care • Rapid Recognition of STROKE Symptoms • Rapid access in to the medical system • Assessment • Treatment
Seven D’s of STROKE Care • Detection –of STROKE symptoms • Dispatch– of EMS/ MET Team • Delivery – to a facility prepared to manage STROKE • Door to treatment– rapid diagnosis and decision making • Data– CT Scan • Decision– Ischemic or Hemorrhagic, does the patient meet the criteria to receive thrombolytic drugs • Drug – thrombolytics when appropriate
EMS Has a Critical Role • Educate your community • At first signs of a possible STROKE call EMS • Many families wait to see if the patient gets better • Take patient to the hospital by car • “Don’t guess call EMS!!”
Use a “FAST” STROKE Assessment • Modification of Cincinnati Pre-Hospital Stroke Screen • Face • Arm • Speech • Time of onset
FACE • Look for Facial Droop • Have the patient smile or show his/her teeth • NORMAL Both sides of the face move equally • ABNORMAL One side of the patient’s face droops or does not move
ARMS • Motor Weakness: Look for arm drift by asking the patient to close eyes and lift arms • NORMAL- arms remain extended equally or drift downward equally • ABNORMAL – One arm drifts down compared to the other
Problem with gripping hands • Many elderly have arthritis in hands • Hurts to grip hands • May mimic weakness
SPEECH • Ask the patient to say “You can’t teach an old dog new tricks” • Lots of t’s, k’s and c’s • NORMAL –Phrase repeated clearly and plainly • ABNORMAL – Words slurred, abnormal or unable to speak
Abnormal Speech • Slurring of speech • Unable to think of words • Inappropriate words • Expressive aphasia – unable to speak words • Area of brain where words are created is damaged • Receptive aphasia – unable to understand words • Area where words are interpreted is damaged
TIME OF ONSET • The window of opportunity to effectively treat STROKE is 3 hours (180 minutes) • May be extended to 4 ½ hours in some cases • Need to know “ last known well”. • Difficult when • Patient lives alone • Woke up with symptoms
180 minutes • Don’t think of as 3 hours, but 180 minutes • Time gets eaten up fast • Short scene time • Take transport time into consideration
Assessing the Stroke Patient • Initial Assessment • General Impression • Airway Airway Airway!! • High-flow O2 • Circulation • HIGH PRIORITY TRANSPORT
Focused history and physical exam • Perform thorough neurologic exam. • FAST Stroke Screen • History of • Seizures • Headache • Nausea/vomiting • Neck pain • Obtain baseline set of vitals • Recheck Vital Signs frequently
Priorities of care • Conduct general assessment • Trauma – recent or within last month • Recent seizure • Could be a subdural hematoma • Cardiovascular – on heart medications • Does the patient have atrial fibrillation • Does the patient take blood thinners • Pulse oximetry > 94% • Blood sugar treat if able • Low blood sugars mimic a stroke • Pupils
Position • Protect potentially paralyzed parts
STROKE Check List • Securing A B Cs • Stroke identification • Use of FAST Screen • EKG monitoring if able • Oxygen saturation of > 94% • Management of blood glucose • IV access (ILS/ALS) • Blood specimens obtained (ILS/ALS) • Head of Bed elevated 15 degrees • Early communication with Physician • Urgent transport to CT Scan
Non Contrast CT of HeadWant a normal CT
Acute Hemorrhagic StrokeBlood shows up white
Sub Arachnoid BleedBlood in meninges due to aneurysm
Could this be anything other than a STROKE? • Transient Ischemic Attack • Hypoglycemia
Race Against Time
Goals of STROKE Care 2013 • Standardized assessments, vocabulary, protocols and goals • Door to treatment (with thrombolytics) goal is 60 minutes • Early identification of candidates • Direct transport to CT scan
NINDS** Recommended Goals • Door to doctor 10 minutes • Door to CT completion 25 minutes • Door to CT read 45 minutes • Door to treatment 60 minutes • Access to neurological expertise* 15 minutes • Access to neuro-surgical expertise* 120 minutes • Admit to monitored bed 180 minutes • * by phone or in person • ** National Institute of Neurological Diseases and Stroke
Case Study 1: 6:30 pm • You are called by a family member to assess a patient who is not acting right. • What could be the problem? • Keep an eye on the time you have 180 minutes
What could be the problem? • Seizure • Code • Myocardial infarction • Diabetic reaction • Medication reaction • Anxiety attack • STROKE
6:35 pm • Upon arrival, you find the patient, Mrs. Short, sitting in bed. She is confused, but responds to verbal stimuli. • What assessments do you need?
ABC/FAST • Airway and ventilations are adequate • Regular pulse and good perfusion • Speech is garbled • Unable to move her right arm and leg • Denies chest pain. • BP 195/105, pulse 90, respirations 18
The patient’s daughter reports that her mother felt fine a few minutes ago when suddenly her arm felt funny. She did not lose consciousness and did not have a seizure. • The woman did not complain of a headache, and has no history of seizures, diabetes, chest pain or palpitations.
- More by User
Stroke. Stroke. Second important cause of death Physical and pshychosocial handicap Lesions of brain parenchima due to pathology of cerebral circulatory system that leads to hemorrhageae or ichemic lesions. Cerebral Anatomy. Vascular circulation: Anterior and Posterior Anterior circulation
2.7k views • 67 slides
Stroke. Damrongsak Bulyalert, M.D., Ph.D. [email protected] www. metadon.net. What is a Stroke?. I nterruption of blood flow to an area of the brain due to narrowing of blood vessels blockage by clots rupture of blood vessel. 2 t ypes of stroke. Ischemia: thrombosis and embolism
711 views • 18 slides
Stroke. Omar Khan, MD MHS February 2006. Etymology before epidemiology. Why is a stroke called a stroke? Maybe since all sudden attacks were called strokes, and the rest acquired specific terms e.g. MI An abbreviation of the phrase 'stroke of apoplexy’
961 views • 47 slides
Stroke. Introduction.
1.03k views • 22 slides
Stroke. Objectives . Define Stroke Review Classifications, Statistics, and Risk Factors Identify Early Warning Signs of a Stroke Identify Primary Impairments Identify Secondary Impairments Recognize Hemispheric Differences Understand Prognosis Review Physical Therapy Interventions
1.82k views • 36 slides
STROKE. Dr Muhammah Ashraf Assistant Professor Medicine College of Medicine, Majmaah University. Objectives. Define stroke and TIA (Transient Ischemic Attack) Enumerate types of stroke Discuss Localization Signs Describe mechanism of Stroke Enlist the risk factor of Stroke
892 views • 15 slides
Stroke. By: Roy Lavi, Marc Christopher, Josh Embry. Treatment and Medicine.
523 views • 12 slides
Stroke. by: Katarina Batinjan Mentor: A. Žmegač Horvat. CVA - medical emergency can cause permanent neurological damage, complications and death in the western world - second most common cause of death and d isability.
581 views • 19 slides
STROKE. Presented By Rochelle Hughes. LUTHER VANDROSS.
400 views • 13 slides
Stroke. Andy Ritson. Definition. Focal neurological deficit of cerebrovascular origin lasting >24 hours <24 hours = TIA Two types: Ischaemic Haemorrhagic. Ischaemic stroke. Pathophysiology. Usually thrombotic embolus Origins: Heart (AF, MI) Carotids (atherosclerosis)
848 views • 46 slides
Stroke. Mark Sudlow Consultant and Senior Lecturer Stroke Northumbria/NHCT/University of Newcastle. Money talks. NAO estimates of cost of stroke £7 billion annually Of which £2.2 billion are direct costs to NHS Cf £1.9 billion for coronary heart disease
698 views • 35 slides
‘ Stroke ’. Cerebrovascular diseases . Vascular diseases of the nervous system are amongst the most frequent causes of admission to hospital. Strokes of all types rank third as a cause of death, surpassed only by heart disease and cancer.
1.07k views • 41 slides
Dr Farzadfard. stroke. Stroke types. Infarcts Artery Vein Hemorrhages ICH IVH SAH. Presentation. Abrupt Onset Fit the distribution of a single vascular territory
714 views • 30 slides
Stroke. Stroke Facts. About 795,000 Americans experience a Stroke (or Brain Attack) each year. About 610,000 of these are first attacks and 185,000 are recurrent attacks. 1 Stroke is the third leading cause of death 2 and remains the leading cause of disability in the United States. 3
919 views • 20 slides
Stroke. Cameron Vassar, Taylor Newcomb, Amber Waddell. Description. A stroke occurs when blood flow is interrupted to a part of the brain. About a third of all strokes preceded by transient ischemic attacks (TIAs), or mini strokes, that temporarily interrupt blood flow to the brain.
303 views • 7 slides
Stroke. Implementing NICE guidance. 2008. NICE clinical guideline 68. What this presentation covers. Introduction Scope Key priorities for implementation Costs and savings Discussion Find out more. Introduction. Stroke is a major health problem in the UK Each year in England:
498 views • 14 slides
Stroke. Z. Rozkydal. Ischemic stroke Temporary or permanent disturbance of the brain due to insufficient blood flow Causes: blood clot in brain vessels Temporary- recovery of the blood flow in 1-4 minutes Permanent 90 percent of all strokes. Ischemic stroke- signs F- facial weakness
192 views • 9 slides
Stroke. John C. Stevenson Martin Birkhäuser Alfred O. Mueck. Stroke. 1. Risk factors, absolute risks 2. MHT – WHI, RCTs 3. MHT – Observational Studies 4. Tibolone, SERMs 5. Experimental Research 6. Stroke prevention, Guidelines, Consensus Statement. Stroke.
814 views • 6 slides
Stroke. Christina M. Allen May 8, 2006. Impact of Stroke. Approximately 700,000 Americans suffer from a new stroke or recurrent stroke each year Strokes kill nearly 157,000 each year Stroke is the number 3 cause of death For every 5 stroke deaths, 2 are men and 3 are women
400 views • 15 slides
- Upload Ppt Presentation
- Upload Pdf Presentation
- Upload Infographics
- User Presentation
- Related Presentations
Geriatric Psychiatry
By: JenniferDwayne Views: 3118
Improve Communication and Independent Living for Individuals with Hearing Loss
By: JenniferDwayne Views: 796
The Autopsy-Who What Why When and How
By: JenniferDwayne Views: 1614
Approach to incomplete longitudinal meniscal tear
By: JenniferDwayne Views: 1115
All you need to know about COVID-19 if you have Asthma
By: JenniferDwayne Views: 820
Gastrointestinal and Genitourinary Trauma
By: JenniferDwayne Views: 1221
Obstetrics and Gynecological Emergencies
By: JenniferDwayne Views: 2509
Abdominal Trauma
By: drdwayn Views: 3424
EMT Refresher B - Medical Assessment and Management
By: firstdue911 Views: 2157
CPR and AED-Assisting A Person in Cardiac Arrest
By: drdwayn Views: 1248
- About : Professor, College of Nursing and Health Sciences
- Occupation : Medical Professional
- Specialty : MD
- Country : United States of America
HEALTH A TO Z
- Eye Disease
- Heart Attack
- Medications
IMAGES
VIDEO
COMMENTS
The sooner a stroke victim gets to the hospital, the sooner they'll get lifesaving treatment. Stroke survivors have the best outcomes when they receive treatment in 4.5 hours or less. may improve the chances of getting better but only if they get help right away.
You can help prevent stroke by learning the signs and symptoms. Share stroke prevention tips with your community using these helpful presentation slides.
• Brain injury from stroke can affect any of the following functions: ability to move, feel, think and behave. • A stroke is a medical emergency. Immediate treatment may minimize the long -term effects of a stroke and even prevent death.
A stroke is a "brain attack" that happens when blOOd flow to the brain is blocked or a blOOd vessel ruptures. When this happens brain cells are deprived ot oxygen and begin to die.
Stroke is a leading cause of death and disability in the United States and worldwide. There are three main types of stroke: ischemic (caused by blockage), hemorrhagic (caused by bleeding), and transient ischemic attacks (TIAs or mini-strokes). Symptoms appear suddenly and without warning, and include numbness, confusion, trouble seeing or speaking.
Clinical presentation includes sudden onset of focal neurological deficits like weakness or seizures. Diagnostics include CT scans. Prognosis is poor with 50% mortality at 1 year. Management focuses on controlling blood pressure, treating increased intracranial pressure, preventing seizures and infections.
When it comes to stroke, time matters. Your immediate action can help prevent brain damage and long‐term disability. KNOW HOW TO REACT. To help you recognize signs of STROKE, remember BE FAST. Now, learn more about these sudden symptoms of stroke.
Stroke in the US • One case of stroke every 45 seconds • Results in devastating disability • 16% institutionalized in nursing homes • 31% assistance with Activities of Daily Living (bathing, dressing eating) • 20% assistance with walking • 30% depressed • Annual cost of $68 billion
In this presentation I have tried to explain in brief about stroke, its etiology, types, diagnostic criteria, and its management. Congestive cardiac failure is defined as a chronic condition where the heart is unable to pump enough blood to meet the body's needs.
Check out this medical presentation on Emergency Medical Services (EMS), which is titled "Stroke", to know about stroke, prehospital care, emergency management, and diagnostic approach.