I finished my annual recertifications this week and learned some very interesting stats about strokes I would like to share with you all.
- Stroke is the third leading cause of
death in the United States.
- 150,000 deaths from stroke occur each
year.
- There are 550,000 new strokes each year.
- In the United States alone there are 3
million stroke survivors. It is the
leading cause of adult disablility.
- Someone suffers a stroke every minute in
this country.
- Over the course of a lifetime, four
out of every five American families will
be touched by stroke.
Despite these staggering statistics, stroke is called America's most neglected disease.
Transient Ischemic Attacks or TIA's--symtoms of strokes that appear for 24 hours and disappear within that same period of time, carry some omnious statistics too. 36% of people who have TIA's will go on to have a completed stroke within 7 years. 51% of those people will have their stroke within the first year; 21% within the first month and 28% within 2-7 years.
But there is hope. Today, new and improved teatment options are available. But time is of the essence. A stroke is an emergency and must be treated quickly. Many times, if you meet the criteria, strokes can be treated with clot busters completely reversing symptoms--even severe ones.But you have to be at the hospital within less than 3 hours after the symptoms of the stroke first appear. Most hospitals now have "Stroke Alert"--so that if you come to the ER with symptoms of a stroke whether by ambulance or family brings you, you no longer wait. A special Stroke Team ushers you in and works with you, because it has been recognized that there is an optimal window of time in which to work with ischemic cellular changes in the brain.
I encourage you to know the various symptoms of stroke that can appear suddenly and seek treatment for you, your family members or friends immediately:
[list]
- Weakness or numbness of the face, arm, or
leg on one side of the body
- Blurred or decreased vision in one or
both eyes
- Confusion, difficulty speaking or
understanding others
- Trouble walking, dizziness, loss of
balance or coordination
- Severe or unexplained headaches
[This message has been edited by RunningSoLate (edited October 31, 1999).]
Answer
Excellent information. Recently I had a loved one die a horrible death from stroke, complicated by misdiagnosis and maltreatment at one of the finest medical facilities in the nation.
The slurred speech and difficulty walking in the hospital was diagnosed as "sundowning syndrome" by the smarmy physician. "It happens to older folks in the hospital all the time", Dr. Dummy said. "But she had a lot of problems walking in the sunlight," I said. "Probably no connection said the kid in white."
"I think it might be a stroke."
"No. Just local tissue ischemia in the leg. You have to encourage her to walk," said Dr. Dummy. He was a vascular man. Got quite a write up in the New Yorker magazine. "A Top man," said the news reporter. Got a big grant to promote a blood-vessel transplant substitute." Yeah.
Sensitivity to sunlight is another stroke indication, by the way.
"She's developing compartment syndrome in the leg." I said. "You read too many medical books" he said, and looked at me in a smiley-faced way. She did develop compartment syndrome. Oh the leg got infected because a student physician had to certify himself in running a probe down the femoral artery and my loved one met the criterion for "practice".
Anyways the trip downhill took a while and it was hard. From perfectly functioning person to blind quadraplegic with first a foot amputated, then a leg, endocarditis (induced by non-sterile hospital technique), an intestinal blockage and colostomy (induced by stopping peristalsis with morphine). Thank you, the Gods of modern medicine. Oh they trached her too. And she died hard.
So stroke is one of my not-so-favorite subjects.
There can be two kinds, though and the differential diagnosis can be difficult. You can have a blockage (usually a clot) or a bleed. Both result in stroke-like symptoms. Treatment is different. There are new agents which dissolve clots, but if you have a bleed then these agents promote bleeding. Not such a good idea. Two commonly used medicines to break clots are called streptokinease and urokinease. There is a tight "window" however, in which these drugs can help.
In an older person be alert for an unexplained stumble or fall. Especially if there was nothing to trip on. Sometimes there is an associated retrograde amnesia. "I can't remember what happened," they'll tell you.
One thing to remember about stroke victims is that they can usually understand everything you say, even though they may appear completely in another world. That means caution in speaking in front of them. They also need kind words of encouragement. Bend over, hold their hand and tell them in the ear: "I know you can hear everything I can tell you, even though you can't talk back and people think you're unconscious." Then tell them the magic words: "I love you."
My guess is you'll get a squeeze back in the hand.
This message has been edited by newyorktwo (edited November 01, 1999).
Answer
I received the e-mails asking me to step in with my 2 cents worth on this subject, so here I am.
Very good info from the ACLS person, but as NY2 mentioned, there are different types of strokes. The initial post in this thread is dealing only with the type caused by a clot. A clot develops and blocks a small blood vessel in the brain which closes off blood flow to the brain matter beyond the clot and that tissue begins to die. In this case the person must get to the hospital within the magic window time and MUST meet certain criteria before the decision to use TPA (Clot Busters) is made. There are some situations where using these new medications can be more harmful than the effects of the clot. Much caution is called for in this decision. These medications can cause bleeding problems elsewhere in the body that can go undetected until there is another medical crisis to deal with.
Another type of stroke is the bleeding type of stroke. A small vessel in the brain ruptures and the blood it carries is now leaking out into the brain itself. This can cause compression of healthy brain tissue in the area of the bleed as well as the area beyond the rupture dying because blood flow is not reaching it.
This type of stroke will not be treated the same way at all. Drastic measures may be required to reduce swelling and releive pressure within the skull to prevent further death of brain tissue. Some of the treatment may be medicinal, some may require surgical intervention.
Regardless, strokes can be deadly at the most and debilitating at the least.
A person who is left with one side of their body totally useless, sight and/or hearing impaired, inability to speak, or eat without help is a totaly different person than they were prior to the stroke.
I must run and go to work right now, but I will return later to discuss more on the aftermath for stroke victims and their families.
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Keeping you safe, healthy, and on the road.
Nurse Red
Visit us at www.Truck.net/abmsVisit us at
Answer
As promised, I am back with more info on strokes.
There was an earlier mention of stroke victims being to hear and understand what was being said or done in their presence even while in a comatose state. This is very true and not only for stroke victims. So always be very careful what you say in the presence of someone you are presuming to be unconscious. They may be unconscious and unable to respond but they can hear and understand. I have seen it proven too many times to doubt this fact.
When a stroke of any type has occurred, there is a general rule of thumb that within 72 hours the stroke will evolve. This means that the stroke will have reached it's maximum level and there will be a better understanding of the damage that has occurred and how well the person is going to fare. Remember that this is a rule of thumb. Not hard and fast information to take to the bank.
Persons experiencing a stroke will exhibit different deficiencies depending on the area of the brain involved in the cerebral accident. Those that sustain injury to the specch are of the brain may blurt out what sounds like gibberish. In their mind they know what they want to say but when they open their mouths, nonsense comes out, They know it is happening and it is very frustrating for them to not be able to put their thoughts into words that are understandable. Others may experience problems with their emotions, laughing at inappropriate times or crying for no apparent reason. They may become angry over something trivial that would never have bothered them prior to the stroke.
What is hardest for the stroke patient is the betrayal of their mind and body. For the family it is watching the changes in their loved one and not understanding what is happening. It is difficult for families to cope with the changes that occur in a family member who was once strong, healthy, and relied upon. That person now becomes as needful as a small child, even infantile in some cases. But that transition is no less difficult for the stroke victim. They resent what has happened. They hate needing to be cared for and with less control over their emotions will tend to lash out at the persons who are trying so hard to help them.
Quite often residual effects of a stroke diminish with time and proper rehabilitation
therapy. Some of the effects remain for the rest of the person's life. A lot depends on the caregivers, whether it be medical personel or family members. Patience and creativity are the key words.
The brain is a miraculous organ that we know very little about. Medical science is learning more and more all the time and great strides have been made in the rehabilitation methods used for stroke victims. Stroke victims are being retrained and sent home where 10 years ago their condition would have meant spending the rest of their days institutionalized.
This is due to the new medications for treatment, advances in rehabilitation, and every discovery that is made towards understanding how the brain really works.
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Keeping you safe, healthy, and on the road.
Nurse Red
Visit us at www.Truck.net/abmsVisit us at
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Good points about there being two types of strokes. If your hospital has a Stroke Alert Team in place--when you arrive in the ER the protocol now is to take you to CT immediately. In fact you are not even supposed to wait for your turn to go to CT--you immediately become the priority person. A CT scan will determine whether you have a stroke caused by a clot or stroke caused by a bleed. If it is a clot type stroke--then you will be evaluated for the use of one of the clot busters. But here again, strict criteria have to be met. A bleed on the other hand may require surgery.
For a Stroke Alert to be in place in your hospital the following time guidelines should be met on arrival to the ER:
- From the time you arrive in the ER with symptoms of a stroke you should be seen by a doctor within the first 10 minutes.
- From the time you arrive in the ER with symptoms of a stroke you should be in CT within 25 minutes
- From the time you arrive in the ER with symptoms of a stroke you should have a treatment protocol determined and in place within 60 minutes
- From the time you arrive in the ER with symptoms of a stroke you should have been evaluated by a neurologist within the first 15 minutes.
- From the time you arrive in the ER with symptoms of a stroke you should be in a monitored ICU bed by 3 hours.
- From the time you arrive in the ER with symptoms of a stroke and it is determined that neurosurgery is called for, a neurosurgeon should see you within the first 2 hours.
I also posted this topic of strokes on Spousal Issues and got interesting responses. Strokes run in our family. My grandfather and all his 8 brothers and sisters died of stroke on my mother's side of the family. My grandmother on my mother's side of the family also died of a stroke. So naturally, these things I learned about strokes interest me.
And NY2, I am sorry that you had to go through that with someone you loved. Unfortunately it is an all too common scenario in hospitals today. But the point you made about hearing is so true. I always tell families that hearing is the last sense to ever leave a person and that it is important to weigh their words carefully when they are near their loved one because they may be able to hear and understand everything we say--they just may not be able to respond. I always "talk" to my patients that are in a coma in a positive way--even telling them what day it is, how long they have been there, what happened to them and who I am, and that we are doing everything to help them get better. If they make progress--I even tell them that they are getting better and just to give themselves some time. I often can tell if my comatose patients can "hear" their family members voices. They can't open their eyes or speak, but their pulse rates go up and so does their BP when their family talks to them.
Answer
As a retired Paramedic, some words of advice;
1. When you or your loved ones get to "that age" (over 40), or have health problems, figure out what hospitals you want to go to in the case of an emergency, and why (stroke center, excellent cardiac program, family md affiliation, etc). Write it down somewhere you or your loved ones can access it.
2. While that pen and paper is out, write down the name of your doctor, and medicines you take/allergies. It might be "on file" at the hospital,,,but you might end up somewhere different, computers are down, etc.
3. Figure out what is the best way to access Advanced Life Support. This in many cases is the Ambulance/Fire Department/Rescue Squad via a 911 call. But if you live very close to a hospital or your local emergency response agency is slow or does not have an Advanced Life Support Program, you MIGHT be better off driving your loved one to the Emergency Department, NEVER DRIVE YOURSELF!!!
You already have one problem, don't add an auto accident to the list.
4. Make sure the Paramedics can see your house number, it should be BIG and LIGHTED!!
When you call 911, as soon as you are released by the complaint writer/operator and if your not needed to urgently care for the ill party, put away the dog and cat, and turn on the outside lights! (see funny cat story below).
5. Try and remember, although everyone in healt care wants you to be satisfied, your are a patient, not a customer. In this case the customer is NOT always right. Just because you don't WANT to be sick, doesn't mean you're not .
Psycho
funny cat story (some parts will only make sense to EMS types)... Had a frequent caller to EMS. 60 something female, history of asthma (among others), drank a bit too much at times, got apprehensive and needed to be assured that she was not having an asthma attack. Never really wanted to go to the hospital, just loneley and nervous.
Went in to the house, did exam, made chit chat, was about to leave when one of the Firefighters announced, "Lady, we found your cat". She replied, as the cat leapt into her arms and nuzzled her face "I don't have a cat, I'm allergic to cats!".
Did 3 albuterol nebulizers before giving in and (reluctantly) intubating her (PO2 dropped dramaticly, along with her LOC). She did however live to go home and laugh about the incident many times!!!