An 84-year-old woman is acting strangely. She complains of a mild headache and has vomited twice. She can't walk well. Her speech is slurred. There is a left-sided facial drooping and weakness of the left arm and leg. She has been on a blood pressure pill. She has never smoked and she exercises regularly. From your first aid background, you suspect she has experienced a stroke.
The term stroke defines any disease that impairs circulation to the brain. It is the third leading cause of death in the United States. There are several causes of stroke:- Deposits build up along the arterial walls and narrow the passageway, slowing the blood flow and eventually forming clots. This impairs circulation to the brain. This is the most common cause of stroke (75 to 85 percent of all cases).
- Clot develops elsewhere and travels through the bloodstream, becoming lodged in a brain artery.
- Blood vessel in the brain ruptures. The affected artery can no longer supply blood to the brain tissues and nerves.
When caring for a stroke victim, you should turn the victim on the affected side so he or she has use of the unaffected side.
The actual signs and symptoms of a stroke depend on its extent, site and amount of resultant brain damage. The most common signs and symptoms include altered level of consciousness, inability to communicate and headache.
Check the victim's eye pupils for size and reaction to light. Pupil size can be described as dilated, mid-size, constricted or pinpoint. Under normal circumstances, 95 percent of the population has both pupils equal in size, but unequal pupils can occur in about 5 percent of the population. Unequal pupils may indicate that increasing intracranial pressure had impaired part of the brain, causing pupil dilation on one side (usually the affected side). Dilation and non-reactivity of both pupils is probably caused by lack of oxygen.
Pupils are normally reactive to light. They both constrict when a penlight is shone into one eye and return to their original size when the light is removed. An unequal reaction to light should increase suspicion of the brain being affected by lack of oxygen. When assessing and describing pupils, remember the acronym PEARL - Pupils Equal and Reactive to Light.
The victim who opens his or her eyes and who can identify who they are, where they are and what day it is, are said to be "awake, alert and oriented." Stroke victims may lose muscle tone on one side of the body, causing the eyelid to sag and the corner of the mouth and cheek to droop.
Check the hands and feet for sensation and have the victim squeeze your fingers of both your hands at the same time. This compares bilateral grip strength.
Keep the head elevated to reduce intracranial pressure. Seek immediate medical attention. Remember that low blood sugar may cause symptoms that mimic a stroke. If the victim can swallow purposely without choking, a sweetened liquid should be given.
Transient ischemic attacks (TIA) or ministroke attacks are brief episodes similar to strokes. They occur when there's incomplete blockage or blockage that lasts for only a short period. TIAs are usually a warning of a possible future stroke and lead to no permanent brain damage. TIAs do not cause nausea or vomiting, nor typically headaches.
Strokes are sudden, severe and debilitating. Appropriate assessment is important to rule out other emergencies and to provide correct care. Good first aid and prehospital care can mean the difference between complete recovery and death. It is important to know how to recognize and manage a stroke when it occurs.