By Sherri Jankowski, RN
Emergency Room Nurses are very quick to spot someone at risk for or having a stroke. However, nurses or other medical personnel in other parts of a facility or in a different type of facility, such as a nursing home may not be as quick, thereby losing valuable time in getting treatment than can mitigate any damages.
The National Institute of Neurological Disorders and Stroke have identified five sudden signs and symptoms that should result in 9-1-1 being called for immediate treatment. The signs include:
- Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
- Sudden confusion, trouble speaking, or difficulty understanding speech
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance, or lack of coordination
- Sudden severe headache with no known cause
These signs and symptoms must be recognized and you need to note the time any of them occurred. In order to be treated effectively, with the best chance of mitigating any long-lasting damages, a person must be treated in an ER/ED with tPA protocol or other treatment within three hours of the onset of when the signs/symptoms started.
In addition, if you think someone might be having a stroke, you have to act FAST! Do the following simple test:
- F – Face: Ask the person to smile. Does one side of the face droop?
- A – Arms: Ask the person to raise both arms. Does one arm drift downward?
- S – Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
- T – Time: If you observe any of these signs, call 9-1-1 immediately.
Never try to transport someone yourself. The ambulance personnel can begin life-saving treatment on the way to the emergency room and you will just waste valuable time in your own car.
While in the ambulance, medical people are going to be attending to your needs. You will probably already have an IV started. Vital signs will be done and will be repeated. Details will be called into the ER/ED that they are transporting you too. More IV lines may be started. Several tests will need to be done to determine the type of stroke and the best treatment required when you arrive at the hospital.
Different Types of Stroke
There are three main types of stroke:
- Ischemic stroke
- Hemorrhagic stroke
- and Transient ischemic attack (a warning or mini-stroke).
If the stroke is Ischemic, and up to 85% are, this means the artery that is supplying oxygen rich blood to the brain is blocked by one or more blood clots. Clot busting treatment, such as tPA, is critical to dissolve and break them up in order to re-establish the blood flow to the brain and prevent the death of any tissue in the affected brain area. By preventing death of tissue, any permanent damage can be drastically reduced.
Hemorrhagic Strokes often require surgery. This occurs when an artery in the brain begins to leak, causing blood to leave the artery and put pressure on brain cells, damaging them. People with high blood pressure and aneurysms (a balloon type of bulge in an artery that can stretch and burst) are examples of what can cause this type of stroke.
In addition, the Hemorrhagic Strokes can be broken down into two types. The most common is the Intracerebral hemorrhage, which is when an artery in the brain bursts, flooding the surrounding tissue with blood.
The second type is a Subarachnoid hemorrhage is a less common type, but it involves bleeding in the area between the brain and the thin tissues that cover it. What both types of bleeds have in common are often a sudden severe headache.
The Transient Ischemic Attack (also called a TIA or mini stroke), is different from the other types of strokes. It is not permanent and the effects may last as little as 5 minutes. The blockage of blood to the brain often only lasts a brief time, usually from a very small clot that moves on. However, this is nothing to ignore. It is just as important to get to the ER/ED and be seen. This is a warning sign that a future, possibly more severe stroke, is going to happen. There is no way to tell, at the onset of symptoms, if the person is having a TIA or a full blown stroke. Because of this, calling 9-1-1 is equally as important. Only hospital personnel will be able to determine exactly what is going on and what treatment is necessary.
According to the latest research published in Circulation.:e2-241, more than a third of people who have a TIA end up having a stroke within 1 year if they don’t receive treatment, and 10% to 15% will have a major stroke within 3 months of a TIA. Those are alarming enough statistics for anyone to understand that this is not something to ignore. Preventing a major stroke can have a life altering change for anyone.
The emergency treatment you receive will start in the ambulance. They may transport you to a facility that has a specialized stroke center for the best treatment. Once at the hospital, several health care workers will be with you, asking questions, doing physical assessments, taking blood samples, and doing brain scans with a CT or MRI to see what type of stroke you may have had. All of this can be a little overwhelming as it happens almost simultaneously and can be a little chaotic. But this is in your best interest.
In addition to the ER/ED physicians, specialists such as a neurologist, a neurosurgeon, or others may be brought in to provide you with the best treatment aimed at getting you the best results. If you do arrive within the three hour time frame from the onset of the symptoms and it is determined that you are having a stroke related to blood clots, a clot-busting drug may be started. tPA, Tissue plasminogen activator, is a thrombolytic and one of the most common drugs given. This improves the chances of recovering from a stroke and have less disability and spend less time in a nursing home rehab unit to recover any loss of cognitive or physical ability.
If the stroke is identified as a bleed or potential bleed, then other procedures may be necessary to stop or limit any damage done. There are endovascular procedures that are a little less invasive than actual surgery. The doctor can actually insert a long tiny tube into a major artery and go to the site where he can install a device, such as a coil or stent, to strengthen a weakened area or a broken area to repair the damage or prevent any bleeding.
Once bleeding has actually started, surgical intervention may be necessary to stop the bleeding. The surgeon usually puts a metal clip in place and this will stop blood loss and any further damage.
Regardless of the type of stroke, there are treatments available. The most important thing to remember is identification of signs and symptoms and getting treatment as soon as possible.
If you have a history of stroke, you are at higher risk of another one. Research shows that 1 of 4 stroke survivors has another stroke within 5 years. The risk of stroke within 90 days of a TIA may be as high as 17%, with the greatest risk during the first week. That is why it is important to treat the most common underlying causes of strokes, including heart disease, high blood pressure, atrial fibrillation, high cholesterol, and diabetes. Am Fam Physician. 2011;83(8):993-1001.
If you want to help minimize or avoid altogether, stroke rehabilitation for someone, please learn the signs and symptoms, follow the FAST protocol, and call 9-1-1. It doesn’t matter if you are a family member at home, a nurse in a facility other than ER/ED, or a home health caregiver, follow these procedures and you may become a person who really makes a difference.
Stroke: Challenges, Progress, and Promise. Bethesda, MD: National Institutes of Health ; 2009
American Heart Association/American Stroke Association. Stroke Treatment.