Hemorrhagic stroke emergency care algorithm. Emergency care for ischemic stroke. What medications can be given for a stroke

A sharp violation of the blood circulation of the brain, as a result of which vital areas nervous system do not receive blood, and neurons die, causing a stroke. The disease manifests itself in a number of life-threatening symptoms. Every year, the disease is diagnosed in every 5 inhabitants of Russia, while death occurs in a third of all cases.

The sooner first aid is provided for a stroke, the greater the chance that a person will remain alive. However, transporting the patient to medical institution must be completed within three hours of the onset of the attack.

Classification

First aid for a stroke at home is an important step to save a person's life.

However, you should be aware that the consequences of an attack can be prevented and the functions of depressed blood circulation can be fully restored only in medical institutions. Therefore, if a stroke is suspected, first of all, you need to call an ambulance team, and then proceed to provide emergency care.

To help the patient, it is important to know the types of the disease and their symptoms.

Circulatory disorders in stroke can be of 2 types:

The ischemic type is called the infarction state of the brain. It develops due to the fact that the arteries that provide the brain with the necessary substances are clogged with a thrombus. In this case, a blood clot can develop in the heart, leg arteries, or any other vessels. As a rule, the main causes of ischemic are vascular atherosclerosis and. It is most often diagnosed in people over 60 years of age.
The hemorrhagic type of circulatory disorders appears due to rupture of the cerebral artery. Hemorrhagic stroke- a consequence of hypertension, when weakened cerebral vessels do not withstand and break. For this reason, hypertensive patients must strictly adhere to the treatment prescribed by the doctor. And in case of increased pressure or arrhythmias at home, strictly adhere to the algorithm to eliminate alarming symptoms. ). This type of stroke mostly affects people between 40 and 60 years of age.

Symptoms

Diagnose a particular type of disorder cerebral circulation at the time of emergency care for a stroke is difficult, but for physicians, the distinction between types is very important, since the type of therapy depends on them.

In order to understand that a person has a stroke, you can use a special technique that will reveal important symptoms of the disease.

U is a smile. The patient's facial expressions change: he can only smile with one half of his face;
D is movement. After the patient raises both limbs, it will be seen that one of them is much lower than the other;
A is articulation. A person affected by a stroke cannot speak clearly;
R is the solution. If at least one of the symptoms appears, emergency care for a stroke should be provided and doctors should be called.

Note!

A "male" stroke has several differences in its manifestations from a "female" one.

The exact sequence and time of manifestation of symptoms cannot be predicted, since each organism reacts to an attack in different ways. In addition, symptoms may vary from different types brain circulatory disorders.

At ischemic stroke the symptoms are more pronounced, and the attack itself is difficult: a person can. In addition, with ischemia, the first signs begin to appear a few days before the attack itself, while the hemorrhagic appearance occurs suddenly.

First aid

If you do not have experience in determining the type of attack, first aid for a stroke is carried out subject to these recommendations.

If the person has not lost consciousness, the algorithm of action before the ambulance arrives is as follows:

Reassure the victim;
Lay it comfortably, giving a higher position to the head and shoulder area;
Ensure free flow fresh air in room;
Remove or unfasten the pressing elements of clothing;
Promote complete rest of the patient.

Note!

First aid for stroke does not allow the use medications before the medical examination of the patient!

What not to do when a stroke occurs:

Independently move the victim or ask him to move;
Apply ammonia;
Give a person food or drink;
Use drugs containing acids to bring the patient to consciousness.

Note!

On how quickly the medical team will be called and the first first aid depends on the life of the patient.

Important Details

If you can distinguish the symptoms of an ischemic type of stroke from a hemorrhagic one, then help is differentiated:

Note!

If a person has hypertension, it is necessary to measure his pressure before the medical examination. Report the results of the study to the doctors. Before their arrival, lower the victim's legs into a bath of hot water.

What to do if the patient is unconscious?

Turn his head to the side so that the tongue does not fall or the vomit enters the pharynx, warm the legs and arms, and provide fresh air.

If a patient has a stroke, accompanied by an extremely serious condition, which has symptoms of clinical death (no breathing and heartbeat, the pupils of the eyes are dilated), it is necessary to provide emergency assistance:

Tilt the patient's head to the side;
If necessary, free the oral cavity from mucus or masses and foreign objects;
Grasp the edges of the lower jaw with your fingers and push it forward;
Do ;
Perform a heart muscle massage.

Statistical data show that the first, competently rendered assistance, and the patient during the first three hours in a medical institution, helps to save a life in 60% of cases. 90% of patients fully restore their health and lead a full life. In 70% of patients, irreversible processes in the blood circulation of the brain will not occur.

Medical help

First aid for a stroke is provided by a team of doctors who arrived at the call.

After a diagnostic examination, doctors carry out a series of measures aimed at restoring or maintaining impaired respiratory or cardiac work.

Honey. help consists in the use of medications, which are used depending on the symptoms and type of stroke. What to do with a stroke in a patient after hospitalization is decided by the doctors of the medical institution.

Prevention and recovery

Many are not ready for the manifestation of a stroke: people ignore the appointments of doctors, they do not systematically treat chronic diseases of the heart and blood vessels.

In addition, regular stressful situations, bad habits and poor nutrition increase the risk of disease several times.

Therefore, in order to prevent the occurrence of this extremely dangerous condition for life and health, you must adhere to the following rules:

Eat right;
Give up bad habits;
Follow all the recommendations of the attending physician;
Monitor your blood pressure;
Watch your weight;
Alternate periods correctly physical activity and rest;
Avoid stressful situations and prolonged depression;
Get outdoors more.

Both ischemic strokes and cerebral hemorrhages, as a rule, develop acutely, and a more acute, catastrophic onset is inherent in hemorrhagic lesions. The clinical picture of a vascular lesion of the brain depends on the localization of its focus; meanwhile, the connection of the clinic with the lesion of a particular artery is not always unambiguous.
When diagnosing vascular lesions of the brain, a thorough history taking is important. The causes of ischemic stroke are thrombosis or embolism of cerebral vessels, most often due to atherosclerosis or other causes (rheumatic heart disease, arteritis, vasculitis, etc.). Intracerebral hemorrhages usually occur when a vessel ruptures as a result of prolonged severe arterial hypertension, less often in blood diseases, collagenoses. Subarachnoid hemorrhage most often develops as a result of rupture of a congenital intracranial aneurysm.
Therapeutic tactics differ depending on the type of lesion, therefore, it is important to correctly establish the nature of the stroke (ischemic or hemorrhagic). However, in many cases, this cannot be done in the first hours of the disease, therefore, at first, measures are taken to normalize the vital functions of the body.

Ischemic stroke treatment

Preventive measures include, first of all, the impact on existing risk factors: ( arterial hypertension, diabetes mellitus, hyperlipidemia, smoking, etc. The use of antiplatelet agents (acetylsalicylic acid), anticoagulants (especially in patients with a high risk of cardiogenic embolism), and in some cases vascular surgery is indicated. In case of episodic transient ischemic attacks - conditions with sudden onset of short-term focal symptoms, usually lasting a few minutes - therapy begins with the appointment of aspirin at a dose of 325-1300 mg / day. If aspirin is ineffective, direct medium molecular weight (heparin) or low molecular weight (nadroparin, parnaparin, peviparin) anticoagulants or indirect anticoagulants (warfarin) are prescribed. The duration of anticoagulant therapy is determined empirically, in most cases, medications are indicated for 2-3 months.
According to the results of recent studies, the use of thrombolytics (in particular, streptokinase and recombinant tissue plasminogen activator) improved survival and outcomes of therapy in patients with ischemic stroke. There are encouraging data for other drugs (eg, antioxidants), but their effectiveness requires clinical confirmation.
Methods of vascular surgery are not among the urgent measures. The operation thromboendarterectomy effectively prevents recurrent acute episodes in patients with severe carotid stenosis. However, with widespread atheromatous stenosis, its use does not make sense.
The early start of rehabilitation measures (physiotherapy exercises, occupational therapy and speech exercises) is important, especially for the prevention of complications of immobility in patients (for example, pneumonia, bedsores, muscle contractures, etc.).

Treatment of hemorrhagic stroke

intracerebral hemorrhage

With intracerebral hemorrhages, the same treatment is carried out as with ischemic stroke, with the difference that anticoagulants are contraindicated. Surgical removal of extensive hemorrhages that cause displacement of brain structures often saves the life of patients. Early removal of hematomas located deep in the brain is rarely indicated, since the degree of operational mortality is high, and the neurological defect remains gross.
To reduce swelling around an intracerebral hemorrhage, mannitol and other osmotic drugs are prescribed. The activity of glucocorticoids in intracerebral hematoma is negligible. Monitoring of intracranial pressure can help evaluate the effectiveness of therapy and avoid significant deviations in the direction of both hypo- and hypertension.
In patients who survive the acute stage, brain function can recover quite well, since hemorrhage has a less damaging effect on brain tissue than ischemic necrosis.

Subarachnoid hemorrhages

Re-rupture of the aneurysm gives a high mortality rate (up to 60%). To avoid rebleeding, patients are placed on strict bed rest and placed in a quiet, darkened room. Constipation must be prevented to avoid straining.
With severe headache and pain in the neck, light sedatives and analgesics are prescribed. Aspirin, which has an antiplatelet effect, is not recommended; anticoagulants are contraindicated. Deep sedation is undesirable, as it may make it difficult to assess the initial and delayed neurological disorders. Glucocorticoids help to reduce pain in the head and neck caused by the irritating effect of blood in the subarachnoid space, but there is no evidence of effectiveness in cerebral edema, sometimes observed in patients immediately after subarachnoid hemorrhage.
An operation that successfully obliterates the aneurysm reduces the risk of rebleeding with a fatal outcome. It is better to clip aneurysms, but other methods are also used, for example, ligation of the proximal carotid artery, induced thrombosis, or strengthening the wall of the aneurysmal sac with plastic material. Most neurosurgeons recommend surgery within the first 72 hours. Early surgery minimizes the risk of rebleeding and reduces the chance of postoperative vasospasm, cerebral infarction, and secondary systemic complications. In operations performed after 10 days and later, the operational risk decreases, but rebleeding occurs more often, so that mortality is higher in the end.
Even after surgical treatment, many patients who have undergone subarachnoid hemorrhage have neurological disorders in the long-term period, the cause of which is, first of all, cerebral vasospasm (reactive constriction of cerebral vessels due to the presence of blood in the cerebrospinal fluid) and hydrocephalus. Currently, there is no effective therapeutic method for the prevention and treatment of vasospasm, however, it can be reduced by the early use of vasodilators (phenylephrine or dopamine) and calcium antagonists, but such treatment must be carried out under the control of intracranial and central venous pressure. Hydrocephalus is often transient and does not require surgery. If there is a significant increase in neurological disorders, it may be necessary to drain the ventricle.

Literature

1. Harrison's Textbook ... Chapter 366, Cerebrovascular Diseases, p. 2336-47.
2. ... Neurological emergencies, p. 129-31.
3. Tanne D, Bates VE, Verro P et al. Initial clinical experience with IV tissue plasminogen activator for acute ischemic stroke: a multicenter survey/ The t-PA Stroke Survey Group. // Neurology 1999; 53(2):424-7.
4. Osborn TM, LaMonte MP, Gaasch WR Intravenous thrombolytic therapy for stroke: a review of recent studies and controversies. // Ann Emerg Med 1999; 34(2):244-55.
5. Adams HP, Bendixen BH, Liera E et al. Antithrombotic treatment of ischemic stroke among patients with occlusion or severe stenosis of the internal carotid artery: a report of the trial of Org 10172 in Acute Stroke Treatment. // Neurology 1999; 53(1):122-5.
6. Kwiatkowski TG, Libman RB, Frankel M et al. Effects of tissue plasminogen activator for acute ischemic stroke at one year/ National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study Group. // N Engl J Med 1999; 340(23):1781-7.

From this article you will learn: what should be the first aid for a stroke. Features of emergency measures at home and on the street, depending on the type of stroke.

Article publication date: 11/25/2016

Date of article update: 05/25/2019

First aid measures for a stroke are a set of actions and measures aimed not only at saving the patient's life. The possibility of restoring damaged brain cells and the functional abilities of the nervous system depends on the time and correctness of its provision. According to foreign and domestic experts, the optimal time for delivering a patient to a medical institution is 3 hours from the moment of illness (the sooner the better).

What should be done in case of a stroke in a person in the first place

Wherever the stroke happens and whatever the stroke is, both the patient himself (if the condition allows), and those around him should act according to a clear algorithm:

Do not panic!!!
Assess the general condition of the patient: consciousness, breathing, heartbeat, pressure.
Identify clear signs of a stroke: unilateral paralysis of the arm and leg, distorted face, impaired speech, unconsciousness, convulsions.
Call an ambulance by calling 103!
Find out the circumstances of the illness (if possible, briefly).
Provide resuscitation (artificial respiration, cardiac massage), but only if they are necessary (lack of breathing, heartbeat and dilated pupils).
Correctly lay the patient - on his back or side, either with a slightly raised head and torso, or strictly horizontally.
Provide conditions for good access of oxygen to the lungs and blood circulation throughout the body.
Monitor the patient's condition.
Arrange transportation to the nearest hospital.

The emergency care described above is generalized and does not include some situations that are possible with a stroke. The sequence of events does not always have to be strictly the same as in the above algorithm. In case of critical violations of the patient's condition, it is necessary to act very quickly, performing several actions at the same time. Therefore, whenever possible, 2-3 people should be involved in providing assistance. In any case, following the algorithm, you can save the life of the patient and improve the prognosis for recovery.

Detailed description of all emergency steps

Each event that includes first aid for a stroke requires proper implementation. It is very important to stick to the subtleties, since any "little thing" can be fatal.

No fuss

No matter how difficult the patient's condition is, do not panic and do not fuss. You must act quickly, coherently and consistently. Fear, fuss, haste, unnecessary movements lengthen the time to provide assistance.

Calm down the patient

Every conscious person with a stroke is sure to worry. After all, this disease is sudden, so the stress reaction of the body cannot be avoided. Anxiety will aggravate the condition of the brain. Try to calm the patient, convince him that everything is not so scary, this happens and doctors will definitely help solve the problem.

Call an ambulance

Calling an ambulance is the first priority. Even the slightest suspicion of a stroke is an indication for a call. Experts will better understand the situation.

Call 103, tell the dispatcher what happened and where. This will take no more than a minute. While the ambulance is on the way, you will provide emergency care.

Assess the general condition

First of all, pay attention to:

Consciousness: its complete absence or any degree of stupefaction (lethargy, drowsiness) is a sign of a severe stroke. Mild forms are not accompanied by impaired consciousness.
Respiration: it may be normal, or it may be absent, intermittent, noisy, frequent or infrequent. Artificial respiration can be done only in the complete absence of respiratory movements.
Pulse and heartbeat: they can be heard well, be rapid, arrhythmic or weakened. But only if they are not defined at all, you can do .

Assess the patient's condition and determine the need for cardiopulmonary resuscitation

Identify the signs of a stroke

Stroke patients may have:

severe headache, dizziness (ask what the person is worried about);
short-term or persistent loss of consciousness;
twisted face (ask to smile, bare teeth, stick out tongue);
violation or lack of speech (ask to say something);
weakness, numbness of the arm and leg on one side, or their complete immobility (ask to raise your hands in front of you);
visual impairment;
impaired coordination of movements.

Lack of consciousness or any combination of these signs - a high probability of a stroke.

Correct position of the patient

Regardless of whether the consciousness and general condition of a stroke patient are disturbed or not, he needs rest. Any movement, especially independent movement, is strictly prohibited. The position may be:

It is forbidden to turn a person on his stomach or lower his head below the position of the body!

If there are convulsions

Convulsive syndrome in the form of a strong tension of the whole body or periodic twitching of the limbs is a sign of a severe stroke. What to do with the patient in this case:

Lay on one side with your head turned to prevent saliva and vomit from entering your airways.
If you can, place any object wrapped in cloth between the jaws. It is rarely possible to do this, so do not make great efforts - they will do more harm than good.
Do not try to spread the jaws with your fingers - this is impossible. Better grab the corners of the lower jaw, try to bring it forward.
Do not insert your fingers into the patient's mouth (threat of injury and loss of a finger).
Hold the patient in this position until the seizure ends. Be prepared for the fact that they may repeat.

On the Importance of the Circumstances of the Illness

If possible, find out exactly how the person fell ill. This is very important, as some of the symptoms of a stroke can be observed in other diseases:

traumatic brain injury;
diabetes mellitus;
brain tumors;
poisoning with alcohol or other toxic substances.

Resuscitation: conditions and rules

An extremely severe stroke that affects vital centers, or is accompanied by severe cerebral edema, occurs with signs of clinical death:

complete absence of breathing;
dilated pupils of both eyes (if only one pupil is dilated - a sign of a stroke or hemorrhage in the hemisphere on the side of the lesion);
complete absence of cardiac activity.

Follow these steps:

Lay the person on their back on a hard surface.
Turn your head to one side, use your fingers to free the oral cavity from mucus and foreign objects (prostheses, blood clots).
Tilt your head back well.
Grab the corners of the lower jaw with 2-5 fingers of both hands, pushing it forward, at the same time open the patient's mouth with your thumbs.
Artificial respiration: cover the patient's lips with any tissue, and firmly leaning your lips, take two deep breaths (mouth-to-mouth method).
Heart massage: place your right hand on top of your left (or vice versa) with your fingers interlocked. Putting the lower palm to the junction of the lower and middle part of the sternum of the patient, perform pressure on the chest (about 100 per minute). Every 30 movements should alternate with 2 breaths of artificial respiration.

What medications can be given for a stroke

If an ambulance is called immediately after the onset of a stroke, it is not recommended to give the patient any medication on their own. If delivery to the hospital is delayed, the following drugs help support brain cells at home (preferably in the form of intravenous injections):

Piracetam, Thiocetam, Nootropil;
Actovegin, Cerakson, Cortexin;
Furosemide, Lasix;
L-lysine aescinat.

Self help for stroke

Self-care for stroke is limited. In 80–85%, a stroke occurs suddenly, manifesting itself as a sharp deterioration in the condition or loss of consciousness. Therefore, the sick cannot help themselves. If you experience stroke-like symptoms:

take a horizontal position with a raised head end;
let someone know that you feel bad;
call an ambulance (103);
adhere to strict bed rest, do not worry and do not move unnecessarily;
release the chest and neck from squeezing objects.

Helping yourself with a stroke

If the stroke is ischemic

AT ideal even first aid for a stroke must take into account the type of disease. Ischemic stroke is more likely if:

arose in the morning or at night at rest;
the patient's condition is moderately disturbed, consciousness is preserved;
expressed signs of speech disorders, weakness of the right or left limbs, facial distortion;
no seizures.

Such patients receive first aid according to the classical algorithm described above.

If the stroke is hemorrhagic

Symptoms that speak in favor:

arose sharply at the height of physical or psycho-emotional stress;
there is no consciousness;
have convulsions;
the occipital muscles are tense, it is impossible to bend the head;
high blood pressure.

In addition to standard care, such patients need:

The position is strictly with a raised head end (with the exception of convulsions or resuscitation).
Applying an ice pack to the head (better to the half in which the hemorrhage is supposed to be - opposite to the immobilized tense limbs).

Features of providing assistance on the street

If a stroke happened on the street, first aid has the following features:

Get a few people to help. Organize the actions of each of them, clearly assigning responsibilities (someone calls an ambulance, and someone evaluates the general condition, etc.).
After laying the patient in the desired position, free the neck and chest to make it easier for him to breathe (remove the tie, unfasten the buttons, loosen the belt).
Wrap the limbs, cover the person with warm clothes (in cold weather), massage and rub them.
If you have a mobile phone or contacts with relatives, let them know about what happened.

Features of providing assistance at home or in any enclosed space

If the stroke happened indoors (at home, in the office, in a store, etc.), then in addition to the standard first aid, pay attention to:

Free access of fresh air to the patient: open the window, window, door.
Release your chest and neck.
Get your blood pressure checked if possible. If it is elevated (more than 150/90 - 160/100 mm Hg), you can give antihypertensive drugs under the tongue (Captopress, Farmadipine, Metoprolol), slightly press on the solar plexus or on closed eyes. If lowered - raise your legs, but you can not lower your head, massage the area of the carotid arteries on the sides of the neck.

How to give first aid for a stroke indoors

First aid effectiveness and prognosis

According to statistics, correctly provided emergency care to patients with stroke with delivery to a medical institution in the first three hours:

saves the lives of 50-60% of patients with severe massive strokes;
in 75-90% allows people with mild strokes to fully recover;
60-70% improves the regenerative abilities of brain cells in any stroke (better with ischemic).

Remember that a stroke can happen to anyone at any time. Get ready to take the first step in helping fight this disease!

Contrary to popular belief, a stroke is not a disease. Yes, such a diagnosis exists and is being made, but more and more specialists cease to consider stroke as an independent disease, calling it a complication of a number of vascular diseases. In terms of frequency, this pathology ranks second among all causes of death. That is why knowledge of its symptoms and diagnostic methods (including the pre-hospital stage) can seriously affect the health status of both the whole society and the individual.

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Types of stroke

Specialists distinguish between two main types of stroke according to its main cause:

Ischemic stroke, arising as a result of various disorders leading to a sharp deterioration in the blood supply to areas of the brain;
Hemorrhagic stroke, which refers to the outpouring of blood from vessels of various calibers; in this case, pathological changes in the brain are caused by a developing and growing hematoma that compresses the brain structures.

There is a separate classification of ischemic stroke, which takes into account most of the diseases leading to its development. It is interesting only for specialists, but it is important for us to understand in what cases this most severe pathology can develop.

Causes of a stroke

Since stroke is considered a complication, a single cause cannot be clearly established for it. Here we are talking more about risk factors that increase the likelihood of this pathology and are divided into two groups:

modifiable and
non-modifiable.

The first includes a number of diseases that lead to damage to the vascular wall or deterioration of blood circulation in a different way:

arterial;
heart disease;
flickering;
transferred in the past;
disorders of fat metabolism (dyslipoproteinemia);
diseases that damage the carotid arteries that feed the brain.

Modifiable risk factors include lifestyle features:

smoking;
excess body weight;
malnutrition with a predominance of saturated fats, lack of plant fibers;
alcohol abuse;
lack or severe lack of physical activity;
use;
decrease in blood testosterone levels;
acute and chronic.

Non-modifiable factors- this is something that cannot be changed by any methods: gender, age, genetic predisposition.

To conditionally non-modifiable factors chronic heart failure can be attributed, which, although it can be compensated to certain limits, is completely impossible to cure.

The factors described above relate primarily to ischemic stroke, which is much more common than hemorrhagic stroke. The development of the latter leads to:

arterial hypertension;
any pathology of blood vessels supplying the brain;
violations of the blood coagulation function under the influence of taking anticoagulants, antiplatelet agents, thrombolytics or due to the pathology of the thrombus formation system;
taking various kinds of psychostimulants - amphetamines, cocaine, etc.;
alcohol abuse.

Situations that can trigger a stroke

The development of complications is also possible against the background of general well-being, however, often the failure of compensation mechanisms occurs in cases where the load on the vessels exceeds a certain critical level. Such situations can be associated with everyday life, with the presence of various diseases, with external circumstances:

a sharp transition from a lying position to a standing position (sometimes it is enough to go into a sitting position);
dense food;
hot bath;
hot season;
increased physical and mental stress;
cardiac arrhythmias;
a sharp decrease in blood pressure (most often under the influence of drugs).

Stroke Symptoms

In terms of diagnosis, stroke is a rather difficult task even for doctors. The usual inflammation of the trigeminal nerve, which innervates the muscles of the face, leads to the appearance of some symptoms that are also characteristic of a stroke. If at this moment a person also has an increase, the probability of an error increases significantly.

However, a stroke is a disease in which it is better for a doctor to assume the worst than to miss its occurrence. Therefore, it should be suspected in all cases when:

there are sudden weakness, numbness, "goosebumps" in the arm, leg, especially if the symptoms appear only in one half of the body;
facial asymmetry appears;
vision decreases or disappears, visual artifacts appear that were not there before (loss of part of the field of vision, “flies”);
speech worsens, becoming incoherent, meaningless;
for no apparent reason, a severe headache appears, especially if its onset is in the nature of a “hit”;
consciousness is disturbed from mild stupor, when the patient reacts to external stimuli with a slight delay, until the consciousness is completely turned off - coma.

To simplify the pre-hospital diagnosis of stroke, a group of British doctors developed the FAST complex in 1998. This is a series of simple manipulations, with the help of which in most cases you can at least suspect this pathology.

The essence of this complex is as follows:

F-face or face. This element consists in determining the symmetry of the face and identifying the paresis of facial muscles. To identify problems, the patient is offered:
- Show teeth. With a stroke, the shape of the mouth resembles a tennis racket - one half of the lips moves apart, while the other remains closed.
- smile. With a stroke, there is a lack of work of facial muscles on one side of the face.
- Puff out your cheeks. With a stroke, one cheek retains its tone, while the second does not inflate (doctors say "sails", from the word "sail").
A-arm or hand. This element is necessary to detect motor and sensory disorders. To detect pathology, the patient is given several tests:
- The lying patient raises both arms at an angle of 45 ° (sitting - at an angle of 90 °). With a stroke, one of the arms lags behind or does not rise at all.
- The doctor raises both hands of the patient above his head, connecting them with his palms, holds in this position for 5 seconds, and then releases. One of the hands is gradually lowered.
- The lying patient is bent both legs in the hip and knee joints at an angle of 90 °. With a stroke, a person cannot hold one of the legs in this position.
- The patient forms a ring from the index finger and thumb (similar to the OK sign). The doctor inserts his index finger into the ring and tries to break it without much force. If successful, a stroke is suspected.
- The patient should squeeze the hands of the doctor with both hands. In this case, the difference in the force of compression, inevitable in a stroke, is revealed.
S-speech or speech. Allows you to identify violations of speech functions, as well as the ability of a person to navigate in space, time and in his personality. The beginning of the identification of this element is a survey of relatives who could note the moment of occurrence of violations. The doctor then moves on to:
- What is your name? How old are you? - the patient may not answer these questions if he is not oriented in himself.
- Where are you? What date, day, month, year is today? - a patient with a stroke may be disoriented in place, time, space and will not be able to answer correctly.
- When receiving answers, the doctor pays attention to the delay time with the answer and the intelligibility of speech.
T -time or time. This is not a diagnostic element, but milestone medical care. There is a so-called "therapeutic window" - 6 hours from the moment the first symptoms of a stroke appear. This period should be taken into account, since it is at this time that it is possible to carry out such therapeutic measures that can completely eliminate the disease.

Diagnostics

Although the FAST complex makes it possible to establish a diagnosis of stroke with a fairly high degree of certainty (80-90%), a full range of measures is needed to finally confirm this fact. Conducting laboratory and instrumental studies also allows you to determine the tactics of further treatment and make a prognosis regarding the outcome of the disease.

The survey begins with a survey of the patient or his relatives. The doctor pays attention to the moment of the onset of a stroke, reveals the dynamics of the development of symptoms. It is very important to find out all about concomitant diseases that could lead to a stroke, as well as learn about the predisposition to it.

At the second stage, routine analyzes and studies are carried out:

At the third stage, instrumental diagnostics is carried out. Computed and magnetic resonance imaging are used to detect the fact of a stroke, clarify its nature (ischemic or hemorrhagic), the affected area, and also to exclude other diseases with similar symptoms. Sometimes these methods are supplemented with angiography, which allows visualizing the state of the vessels in the area of necrosis and adjacent tissues.

Doppler ultrasound also allows you to find out what condition the vessels of the brain are in, to assess the degree of their narrowing and deterioration of the blood supply to intracranial structures.

Other diagnostic methods provide little data to help doctors, so they are usually not used.

This is the most insidious form of cerebral ischemia (malnutrition). Its danger is that the symptoms characteristic of a stroke occur rather quickly and disappear just as quickly (within an hour). Being not too pronounced, they often pass by the attention of the patient and do not alert him. But even Hippocrates wrote: "Unusual attacks of numbness and anesthesia are signs of impending apoplexy"(apoplexy used to be called all forms of stroke).

Transient ischemic attack is not nearly as harmless as it seems. According to researchers, in the presence of ischemia within half an hour, a third of patients already have organic changes in the brain tissue. That is why, when the the slightest sign stroke (even if they disappeared after a few minutes), you should immediately consult a doctor to diagnose and prevent disorders of the blood supply to the brain.

Stroke treatment

Stroke is an extremely serious complication, and therefore its treatment should begin as early as possible. However, drug therapy should not always be applied in the first minutes, as often the rush to prescribe drugs worsens the prognosis of the disease.

The main rule is to call an ambulance, provide first aid if necessary and send the patient to the hospital, where he will be given a full range of therapeutic measures:

adequate supply of oxygen;
control of respiratory functions;
decrease in the severity of cerebral edema;
elimination of possible fever;
correction of disturbed metabolic parameters;
symptomatic treatment.

In addition, specialists may prescribe specific treatment:

thrombolysis (the introduction of special drugs that dissolve a blood clot in the vessels of the brain);
anticoagulant and antiplatelet therapy for the same purpose;
surgical intervention to remove a blood clot, vascular plasty.

Timely treatment of stroke can significantly limit the focus of necrosis of the brain tissue. As a result, a person can avoid death, and in some cases, disability. However, stroke is still an extremely serious pathology, which should be treated only under the supervision of a physician.

Bozbey Gennady Andreevich, emergency doctor

Navigation

First aid for a stroke should be provided to a person as soon as possible. Correctly taken actions, as well as measures aimed at saving lives, will alleviate the condition of the victim before the arrival of qualified medical workers.

The ease of subsequent recovery of damaged cells, as well as the nervous system, directly depends on how correctly these actions are performed. It is necessary to take the person to the hospital within 3 hours after the discovery of the disease.

Priority measures

First aid for a stroke at home should be provided as correctly as possible. Regardless of where the stroke occurred and what caused the stroke, caregivers should act according to the following algorithm:

Do not panic;
Assess the general condition of the victim. First aid for a stroke begins with identifying the presence of consciousness, breathing, and heartbeat;
Call an ambulance;
When the first signs of a stroke are detected, it is necessary to provide resuscitation assistance, but only if clearly necessary;
The correct position of the patient's body is also very important. Before providing first aid for a stroke, you need to lay the person correctly, on his back or on his side;
Urgent care in a stroke, it involves providing oxygen access to facilitate breathing;
You need to constantly pay attention to the state of the person.

The above describes the general measures to be taken in the event of a stroke. First aid must be competent and timely, so that a person has not only a chance to survive, but also to fully recover from an illness. If there are pronounced violations of the patient's well-being, all measures must be taken very quickly. It is better if first aid for heart attack and stroke is performed by several people.

Detailed description of required steps

It is important to observe all the subtleties, because any mistake can worsen the situation.

But even if the signs of a stroke and microstroke in a woman are very obvious, there is no need to panic. Responders need to act quickly. Fear and unnecessary movements can lengthen the time to help and lead to negative consequences.

The patient should be reassured if he is conscious. The first thing to do in case of a stroke before the ambulance arrives is to assure the conscious person that they will definitely be helped. Illness of this kind always begins suddenly, so a strong stress reaction will be present necessarily.

Anxiety can exacerbate an already deteriorating state of the brain.

Calling an ambulance is very important, you should make a call as soon as possible. A minimal suspicion of a microstroke should be the basis for contacting specialists who are able to understand the situation much better and more correctly. Having phoned, you should transfer the data about the incident to the dispatcher, clearly name the place. All this will help save precious minutes while the health workers are on the way, first-aid medical care should be provided.

The following factors will help assess the condition:

The presence of consciousness. Absence, as well as cloudiness, are a sign of a serious condition. This does not happen in mild cases.
Breath. Action algorithm involves an assessment of breathing and the presence of its violations, for example, discontinuity. Artificial respiration should only be given to a person if there is no chest movement.
Pulse. You should listen to the heartbeat to understand its frequency and the presence of a rhythm. It is allowed to do a heart massage only if the pulse is not absent at all.

It is equally important to understand the features of a stroke and the symptoms in order to provide first aid in accordance with them. You need to ask if severe pain in the head bothers you, if dizziness is present. in men and women - a distorted face, the inability to smile or make another simple facial action, the presence of a speech disorder, less often - its complete absence.

There may also be weakness, numbness of one or both sides, the presence of immobility. You need to understand if there is visual impairment and problems with coordination of movements. The combination of the symptoms described above indicate the need for emergency care.

Correct position

Regardless of the presence of problems with consciousness, it is necessary to provide a person with peace. Movement, and especially attempts to move independently, should be excluded.

First aid initially boils down to the need to lay the victim on his back, raising his head and chest, if he is conscious. A horizontal position, implying a turn of the head to one side, will be necessary for fainting, convulsions.

The use of medicines

When health workers have already been called, first aid does not involve the use of medicines. But if the process of delivery to the hospital is delayed, the following can help the brain, which are preferably administered intravenously:

Paracetam;
Thiocetam;
Nootropil;
Cortexin;
Furosemide;
L-lysine;
Actovegin.

Measures for micro stroke

The main features of the selection of the diet are as follows:

After an attack, you need to restore the physiological minimum. To do this, a person is given from two liters of liquid per day, which can be in the form of various broths, weak tea, and milk.
The acute period is the time when you should eat low-calorie food, but the nutritional value should be sufficient to fully support the patient's life.
The first day after a stroke is the most difficult, food at this time is ground to gruel, a person needs to be fed. It is necessary to drink from a small teapot or a special bottle.
If there is no swallowing reflex, food is delivered using a probe, in which case it is prepared as liquid as possible, with vitamins. In case of serious neurological disorders, if motor functions are lost, it is quite possible to make a decision on the intravenous administration of special solutions.
After the ability to swallow is restored, and the general condition improves, you can eat solid foods: vegetables, steamed cutlets, mashed potatoes, eggs.

Features of the diet

Proper nutrition is just as important as timely medical care. A person should completely abandon fatty and sweet, you can not drink coffee or tea. If a person recovering from a stroke is hypertensive, his diet must contain a lot of buckwheat, figs, oatmeal, which contain very useful magnesium and potassium salts.

To normalize the functioning of the digestive system, it is advisable not to resort to the use of medicines, but to choose the right nutrition scheme. It is better for a person to use only black bread made from coarse flour. Drink plenty of water and eat fresh fruit.

First aid effectiveness level

If you believe the statistics, then the correct provision of medical care to the victim and the coordinated actions of people who help a person before the arrival of doctors provide huge benefits in terms of recovery.

If all stroke actions are done correctly, the chances are as follows:

50-60% of massive strokes end up saving the patient's life;
75-90 percent chance of complete recovery with mild stroke;
The chance of recovery and restoration of the abilities of brain cells improves by 60-70%, regardless of the type of stroke.

It must be understood that an attack can occur in any person, regardless of age and location. To prevent a stroke, you should carefully monitor your diet, physical and mental condition. Preferably, forget about. The benefit will be the control of one's own and the timely appeal to the doctor when it is exceeded.

The minimum amount of stress will also help you feel healthier for longer. It is important to treat any diseases of the vessels and especially the heart, even if they are not so dangerous. When sick diabetes you need to be constantly monitored by a doctor.