STROKE IS A MEDICAL EMERGENCY

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STROKE IS A MEDICAL EMERGENCY
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AIM

• That by the end of the training session you will
  understand the effect on stroke survival and
  quality of life if stroke is treated as a medical
  emergency

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OBJECTIVES

• Have an understanding of stroke
• Know the signs of stroke
• Have an understanding of why stroke is a medical
  emergency
• Have an understanding of treatments for stroke

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What is a stroke?

• Damage to part of the brain
• Caused by a problem with its blood supply
• Blood is supplied through arteries
• There is a blockage or burst
• Usually happens quickly and strikes suddenly -
  brain attack

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Transient Ischaemic Attack

• A Transient Ischaemic Attack (TIA), also known as
  a mini stroke, occurs when the brains blood
  supply is briefly interrupted
• Classification effects last no longer than
  24hours from onset or the symptoms start to
  resolve within 120 minutes

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Transient Ischaemic Attack

• Having a TIA shows a 10 risk of having a stroke
  within seven days
• Or 20 risk in the first four weeks following the
  TIA

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Ischaemic stroke

• Ischaemic (69)
• Death of tissue because of
• Thrombosis a solid clot of blood in artery
  supplying brain or
• Embolism a clot or other substance (fat,
  cholesterol, blood platelets) carried from
  elsewhere in circulation

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Haemorrhagic stroke

• Haemorrhage (19)
• Bleeding in the brain
• Burst blood vessel e.g. artery
• High blood pressure can weaken artery
• Bursts and damages tissue
• Brain damage is the result

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Stroke Facts

• In the UK
• Every five minutes someone is having a stroke
• Stroke is the third largest cause of death
• Approximately a third of people will die within
  the first 10 days
• At any one time there are over a quarter of a
  million people disabled by stroke
• 80 of strokes are preventable

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Stroke helpline Website 0845 3033
100 www.stroke.org.uk
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FAST

• Research funded by The Stroke Association has
  shown that the
• Face, Arm, Speech Test (FAST) has been highly
  successful in a
• correct diagnosis of suspected stroke. FAST
  requires an
• assessment of three specific symptoms of stroke.
• Facial weakness Can the person smile? Has
  their mouth or eye dropped?
• Arm weakness Can the person raise both arms?
• Speech problems Can the person speak clearly
  and understand what you say?
• Test all three symptoms

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What to look for

• Is there any facial weakness?
• Is there a weakness of the arm or leg?
• Is there a sudden numbness of the face or one
  side of the body?
• Is there a loss of balance?
• Is there a lack of coordination?

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What to look for

• Is there a sudden onset of confusion?
• Can the person speak clearly?
• Can the person understand what is being said?

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What to look for

• Is there a sight problem in one or both eyes?
• Is there any dizziness?
• Is there a sudden severe headache with no known
  cause?

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Stroke helpline Website 0845 3033
100 www.stroke.org.uk
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The current story

• Despite the fact that the impact of stroke can be
  significantly reduced and patient outcomes
  improved by treating stroke as a medical
  emergency, there is evidence that stroke is
  consistently not being treated as an emergency

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Why stroke needs to be treated as a medical
emergency

• Issues key to patient outcomes are
• What happens when someone shows the first signs
  of having a stroke
• How quickly they receive diagnosis and treatment

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Gold standard emergency stroke care
Category B
By three hours
Within three hours
Call Go to GP
Signs of stroke
Rehab
Treatment
Scan
Transfer to stroke unit
Para-medics identify stroke
Call 999
Call NHS Direct
Patient goes to AE
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Time is Brain

• The average forebrain has 22 billion neurons.
• If a person has a stroke in this area
• It will lose 120 million for every hour a
  stroke goes untreated
• That will accelerate its ageing by 3.6 years

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Onset of Stroke

• Infarct
• IschaemicPenumbra

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6 hours post onset

• Infarct
• Ischaemic penumbra

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Traditional Therapies

• Administering aspirin
• Monitoring oxygen saturation, glucose levels,
  hydration
• Temperature and blood pressure control

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Thrombolysis

• Is the breakdown (lysis) of blood clots by
  pharmacological means
• It is colloquially referred to as clot busting
  for this reason From wikipedia 18/01/07
• Given early enough they can dissolve the clot
  restricting the flow of blood to the brain

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Thrombolysis centres in UK

• 0.2 Thrombolysed in 2005
• European aim for 5
• Largest centres Edinburgh, Glasgow, Newcastle
  South London

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Traditional therapies and thrombolysis

• Have a more beneficial and dramatic impact the
  quicker they are administered (Hyper acute care)
• But! thrombolysis is often only effective if
  administered in the first three hours following
  symptoms onset

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Current technologies

• Use of perfusion CT / MRI scans to ascertain the
  potential for reperfusion of the brain
• Craniotomy to reduce pressure on the brain

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Future technologies

• Telemedicine
• Increasing window for thrombolysis
• Stroke Lysis Box
• Possible Scanners on board Ambulances

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Why 999?

• Fast and efficient assessment
• and treatment can reduce
• the effects of stroke

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FAST

• Research funded by The Stroke Association has
  shown that the
• Face, Arm, Speech Test (FAST) has been highly
  successful in a
• correct diagnosis of suspected stroke. FAST
  requires an
• assessment of three specific symptoms of stroke.
• Facial weakness Can the person smile? Has
  their mouth or eye dropped?
• Arm weakness Can the person raise both arms?
• Speech problems Can the person speak clearly
  and understand what you say?
• Test all three symptoms

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Stroke helpline Website 0845 3033
100 www.stroke.org.uk