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Hemorrhagic stroke emergency care algorithm. Stroke emergency care: typical symptoms of brain damage and rules for providing first aid. Provide a normal supply of fresh air

A stroke is an infarction of the substance of the brain, which occurs as a result of a lack of blood circulation in the pool of any of the cerebral arteries.

With a stroke, there is a decrease or cessation of blood flow in certain structures of the brain. There are two types of strokes: ischemic and hemorrhagic. In the first case, a violation of cerebral circulation occurs due to a lack of blood flow, in the second, a rupture of the vascular wall and hemorrhage into the brain occurs. In both cases, brain cells suffer from a lack of nutrients and oxygen, as a result of which their destruction begins, and if first aid for a stroke is not provided on time, irreversible changes in the brain may occur, followed by the victim's disability. Often, the result of a stroke can be fatal.

Causes of Stroke

As mentioned above, impaired cerebral circulation can be the result of a vessel blockage or hemorrhage.

Blockage reasons:

  • thrombosis (the formation of blood clots in the vessels of the brain, which is most often a consequence of atherosclerosis);
  • embolism (the entry of an embolus (foreign matter) into the cerebral arteries, for example, a fatty embolism of the brain with fractures of the long bones).

The causes of cerebral artery rupture and hemorrhage are:

  • arterial hypertension;
  • congenital thinning of the vessel wall (aneurysm).

The development of a stroke is also provoked by the abuse of fatty foods, excess weight, smoking, and alcohol abuse.

Signs of cerebrovascular accident

To recognize a stroke in time, you need to know its signs, which include:

  • a sharp increase or decrease in blood pressure;
  • sudden and severe headache, nausea, vomiting, flashing of flies before the eyes - symptoms of increased intracranial pressure;
  • lack of coordination or loss of consciousness;
  • speech impairment;
  • decreased vision or double vision;
  • violation of orientation in time and space, in relation to oneself;
  • unilateral paralysis and paresis of the limbs or any half of the face;
  • tremor (trembling) of the tongue or deviation in one direction.

First aid for stroke

If suddenly in someone from your environment you notice signs of impaired blood circulation in the brain, then you should act immediately. First aid for a stroke is an ambulance call. If you call an ambulance in time, you will already do almost everything to save a person from the consequences of a stroke.

While the ambulance is driving, you can do the following:

  • reassure the patient, as fear and excitement only aggravate the symptoms of a stroke; in this case, you can give the patient a tincture of valerian and / or moisten the upper lip with it under the nose;
  • loosen the collar of the shirt or the belt of the trousers;
  • give the patient's head an elevated position;
  • provide fresh air access to the room;
  • if you find a stroke at home, and you have a tonometer at hand, then you need to measure your blood pressure, and if it is high, give the patient a drink of the appropriate medications prescribed for the patient earlier. In addition, with increased pressure, you can lower the patient's legs into a basin of hot water in order to redistribute blood and reduce pressure in the cerebral artery system;
  • in case of loss of consciousness, lay the victim so that the head lies on its side in order to prevent aspiration of vomit (with a stroke, vomiting may occur). If vomiting does occur, you need to clear the respiratory tract of gastric contents. In addition, you need to pay attention to whether the tongue has sunk, and if this is the case, pull the tongue out;
  • no need to give the patient vasodilators;
  • no need to feed or drink the patient.

If the case is not particularly severe, then emergency care for a stroke may consist in a massage of the forehead and temples with a gradual transition to the occipital region. You can also massage the neck area and large joints of the limbs. In addition, acupressure may be helpful for minor strokes.

It also happens that the victim at the time of the stroke is driving a car. In such situations, due to impaired cerebral blood flow, not only the driver himself can suffer, but also other road users. Medical assistance here will be as follows:

  • call an ambulance;
  • open the windows in the car, and it is better to help get out of it;
  • measure blood pressure and, if it rises, give the drug prescribed by the doctor to the patient; if the pressure figures are unknown to you, then it is better to avoid taking medications and try to take the victim to the hospital;
  • if the trouble caught you in nature, you can put your feet in a bowl of hot water;
  • in case of loss of consciousness, check the adequacy of air access, exercise control over breathing and pulse, in the absence of a pulse, proceed to indirect heart massage.

After the ambulance arrived to the call, and first aid was provided, it is better to accompany the patient personally to the place of hospitalization (and it is shown to such patients in 100%). Indeed, in the hospital you can give the attending physician as much information as possible about the patient and the disease itself. In addition, it is worth making sure that the victim underwent a computed tomography of the brain, which will help to reliably determine whether there is a cerebrovascular accident, as well as a more specific localization of the pathological process.

Remember that if, with symptoms of a stroke, the first aid to the patient is provided in the first three hours from the onset of the disease, then the victim's chances of surviving are significantly increased, and also not to remain deeply disabled after the stroke.

You also need to know that it is better to prevent cerebrovascular accident than to treat it later. Therefore, at the first signs of this disease or the presence of arterial hypertension, it is necessary to carefully examine and further correct the blood pressure figures throughout life.


1. What is a stroke?
A stroke is a transient dysfunction of the brain due to disturbances in its blood supply. Violations of the blood supply to the brain in stroke may be associated with the development of ischemia (anemia, lack of blood supply) due to blockage of the vessel or narrowing of the vessel lumen by a thrombus, or atherosclerotic plaque, or due to a violation of the integrity of the vessel or the permeability of its wall and subsequent hemorrhage. As a result, the affected area of ​​the brain cannot function normally, which can lead to impaired motor and sensory functions on one side of the body.


Stroke: Lost Time = Shocked Brain Cells

Stroke is a serious medical emergency that can lead to irreversible functional impairment and even death. The sooner the provision of qualified medical care for stroke begins, the higher the chances of saving life and restoring lost functions. After an ischemic stroke, the degree of irreversible damage to brain cells (neurons) steadily increases as long as the affected parts of the brain are left without sufficient blood supply. In areas of the brain completely devoid of blood flow, neurons begin to die in less than 10 minutes. In areas where<30% нормального кровотока, нейроны начинают умирать в течение одного часа. В областях с 30% -40% от нормального кровотока некоторые нейроны некоторые нейроны теоретически могут восстановиться при начале терапии через несколько (3-4-6) часов.

Therefore, it is optimal if medical assistance begins to be provided no later than 3 hours from the onset of the stroke. After 3 hours from the onset of the disease, the brain cells in the ischemic zone begin to undergo irreversible changes. The maximum time ("therapeutic window") before the start of thrombolytic therapy in ischemic stroke is 4.5 hours. In the period up to 6 hours after the onset of the development of a stroke, among the brain cells that have died from ischemia, individual cells are still preserved, which are theoretically able to recover when the blood supply is restored.

2. How to recognize a stroke?

Signs of a stroke can include one or more of the following symptoms:
■ weakness, paralysis (inability to move), or numbness of the face or limbs on one side of the body;
■ sharp deterioration of vision, blurring of the image, especially with one eye;
■ unexpected speech difficulties, slurred speech, falling language, deviation of the language in one direction;
■ unexpected difficulties in understanding speech;
■ sudden difficulty swallowing;
■ unexplained falls, dizziness, or loss of balance. Attention: if a person does not drink alcohol, but behaves "like a drunk" - this symptom may indicate the development of a stroke. The presence of alcoholic intoxication also does not exclude the development of a stroke. Be more attentive to people who look "drunk" - maybe you can save someone's life!
■ sudden severe (most severe in life) headache or new unusual headache pattern for no specific reason;
■ drowsiness, confusion, or loss of consciousness.

A person with no medical background can use a simple pre-hospital Cincinnati Stroke Assessment Test:

The sudden onset of any of these three symptoms indicates the possibility of a stroke. We urgently need to call an ambulance! It is better to overestimate the severity and danger of the patient's condition than to underestimate!

When assessing the patient's condition, keep the following in mind:
- A stroke can change the level of a person's consciousness.
- In many cases with a stroke "nothing hurts"!
- A stroke victim can actively deny their painful condition!
- A stroke victim may inadequately assess his condition and symptoms: focus on your subjective opinion, and not on the patient's answer to the question "How does he feel and what bothers him?"

IMPORTANT:
There is a condition called a transient (transient) ischemic attack, when the blood supply to the brain is temporarily interrupted, causing a "mini" stroke. Even if the observed symptoms of a stroke were mild and passed after a certain period of time, the tactics of action should be exactly the same as in the case of a "large" stroke: put the patient in a position that is safe for vomiting, ensure his immobility and immediately call an ambulance. A "mini" stroke can be a precursor to the development of a "large" stroke.


First aid for stroke.

The most important first aid for a stroke = call an ambulance immediately!

"Russian" features of calling and interaction with the ambulance brigade:

If a stroke happened in a public place or on the street, and even with a crowd of people, then there will be no nuances in communicating with the ambulance. If the patient is at home, then some sovereign Russian peculiarities of the ambulance work may appear, about which you need to know in advance and be ready for them.

1. If you are most likely confident in the diagnosis, inform the ambulance by calling the ambulance that the patient has a stroke and requires the arrival of a neurological team. To the question "How do you know about the diagnosis?", in a confident voice, inform that the diagnosis was made by a doctor-neighbor or a doctor-relative and demanded to immediately call the neurological ambulance team. According to statistics, an ambulance dispatcher is able to correctly determine the diagnosis of "stroke", taking into account the confused story of the caller, only in 1/3 of cases. The arrival of a regular, rather than a neurological ambulance team, can lead to a loss of time before starting to provide medical care in a hospital. During negotiations with an ambulance, someone must constantly be near the patient!

2. Send someone to the neighbors for help: you will need 2-4 strong men in order to carefully carry the patient on a stretcher from the house to the ambulance. If you have not yet come across a Russian ambulance, then you should know that not in all, but in many cases doctors-paramedics-orderlies-drivers ambulances (at least in St. Petersburg) refuse to carry patients on a stretcher into an ambulance car, arguing "that it is not their responsibility" or "they are not strong enough", or they demand money for carrying patients. Any delay plays against the patient: prepare your porters in advance. Don't conflict with ransomware- you can waste precious time on providing medical care. Agree to their terms: remember that life and health are much more important than money. It will be possible to deal with the extortionists after the patient's condition is stabilized in the hospital. To do this, ask someone from your family or neighbors to be present at the "bargaining" and imperceptibly record the fact of extortion of money on a mobile phone (video, dictaphone) and later contact the police with these materials: it is necessary to fight against outright lawlessness using the helpless position of patients.

The duties of doctors, paramedics and ambulance drivers to transfer patients to an ambulance car are fixed in the annexes to Order No. 100 of the Ministry of Health of the Russian Federation dated 03.26.1999.
Appendix No. 9 Regulations on the doctor of the ambulance mobile team: The doctor is obliged (clause 2.3) Provide gentle transportation with simultaneous intensive care and hospitalization of the patient (victim).
Appendix No. 10 Regulations on the paramedic of the ambulance brigade: The paramedic is obliged (clause 2.7) Ensure the patient is carried on a stretcher, if necessary, take part in it (in the working conditions of the team, carrying a patient on a stretcher is regarded as a type of medical care in a complex of medical measures). When transporting a patient, be next to him, providing the necessary medical care.
Appendix No. 12 Regulations on the driver of the ambulance brigade: Responsibilities of the driver: (clause 2.5) Provides, together with the paramedic (paramedics), carrying, loading and unloading patients and victims during their transportation, assists a doctor and a paramedic in immobilizing the limbs of the injured and applying tourniquets and bandages, transfers and connects medical equipment. Provides assistance to medical personnel accompanied by mentally ill patients.

Those who do not believe that the ambulance doctors in St. Petersburg "do not know how" and "do not want" to carry patients on a stretcher, I propose to watch a fresh video from CCTV cameras showing how a patient with a criminal closed craniocerebral injury (according to a press report, the victim Denis was beaten at the entrance) "doctors" are transferred to an ambulance:

3. Some emergency doctors may argue that it is dangerous to take a patient with a stroke to a hospital because he or she is "about to die", and that "it is better to write a refusal to hospitalize" and leave the patient to die at home. Unscrupulous ambulance doctors use this technique to protect themselves from the death of a patient in an ambulance and subsequent organizational conclusions. The mortality rate for strokes is quite high and amounts to 35% at the hospital stage. Insist on hospitalization - you must give the patient a chance to live and recover. Without the immediate provision of qualified medical care, the patient's chances of surviving or avoiding severe disability will be much less. If the ambulance doctor refuses to hospitalize the patient, dial the ambulance phone and report the situation. It is possible that they will not react to your appeals. You can also threaten to call (or call) the police and report the doctor's inaction and leaving the patient in danger. Another technique used by doctors who have forgotten the Russian doctor's promise (the Hippocratic oath) is an "unclear diagnosis." Such doctors claim that they cannot establish a diagnosis. No diagnosis - no hospitalization. If you are faced with such ambulance doctors, call a paid ambulance: time is against you and the patient's life. Remember that a paid ambulance will cost much less than a funeral for a patient who is left without qualified medical care. In the hospital, doctors can no longer refuse to provide assistance.

4. Patients with ischemic stroke are hospitalized in a neurological hospital (90% of stroke cases). Patients with hemorrhagic stroke are hospitalized in a neurosurgical hospital (10% of stroke cases). The type of stroke can only be determined by an ambulance doctor. As you know, not all hospitals in Russia are "equally good." An ambulance may refuse to take a patient to a "good" hospital, and offer only a "bad" one for hospitalization, known for disregarding patients. Prepare money in advance to pay the ambulance staff to transport a patient with a stroke to a "good" hospital. If you have acquaintances in the hospital: call them in advance and warn them that you are bringing them a patient with a stroke and ask them to conduct an initial examination, instrumental diagnostics and start providing medical care immediately. Usually, ambulance doctors demand to tell them the full name of the hospital doctor with whom there is an agreement for hospitalization. Prepare this data in advance so as not to waste time.

5. Upon arrival at the admission department of the hospital, contact the acquaintances with whom you previously phoned, or, in the absence of such, to the responsible doctor and explain that the patient has a stroke, and every minute is precious before the start of medical care (remember the rule of 3 hours from the onset of a stroke). Say that the life and health of the sick person is dear to you and you will pay for the immediate start of diagnosis and medical care. Otherwise, in the evening in hospitals in large cities, such as St. that care for stroke should begin in a prioritized order, just like, for example, with myocardial infraction.

If you are in a region where there is no ambulance or an ambulance arrives in a few hours (or does not always arrive - "no gasoline", "no bridge", "no roads"), then it is necessary to transport the patient in a lying position on his side (for warning inhalation of vomit), ensuring airway patency to the nearest medical facility where assistance can be provided. It is better to call there in advance and warn that you are taking a patient with a stroke.

What to do before the ambulance arrives?

The main tasks of relatives and friends before the arrival of an ambulance to a stroke patient:
■ Maintain airway, breathing and circulation.
■ Prevention of complications.
■ Reducing the severity of the consequences of a stroke.
■ Preparation of documents (passport, medical policy) and important information about the patient (chronic diseases, drug intolerance).

1. Reassure the patient, inform him that you are taking care of him, and that an ambulance will be arriving soon. If a patient with a stroke is not in contact with you due to confusion, this does not mean that he does not hear or understand you. The less stress / anxiety the patient has, the greater the chances of a better outcome.
2. Do not give the sick person anything to drink or eat. Do not give the sick person any medication.
3. Place the patient on a horizontal surface. The less the patient moves, the less chance of increased bleeding (if any), separation of a blood clot or vasospasm. If the patient is conscious and there is no vomiting, then it can be laid on its back. It is not worth raising the head and shoulders: the horizontal position of the head provides better blood supply to the brain. Remove dentures and food residues from your mouth. Raising your legs a little will improve blood flow to your head. Don't let the sick person move.

Vomit:

If the patient is unconscious or vomiting (vomiting): Immediately turn the patient onto their side, immediately keeping the head in a lateral position to remove vomit. Inhalation of vomit can lead to suffocation of the patient or the subsequent development of severe pneumonia. It is necessary to monitor the position of the tongue so that its retraction does not block the airways.

Giving the patient a safe position on his side:

Kneel down next to the person. Turn him on his side to face you. Extend his lower arm forward at a right angle. Bend his upper leg at the knee, the other leg should be straight. The bent leg with the knee should rest against the surface. Tilt your head and neck back and down slightly so that the contents of your mouth (if any) can drain freely downward. Pull your jaw down and check airway patency with your finger. Remove food debris or vomit. Hold his jaw so that his mouth is open all the time. Check for free breathing: are there chest movements? Do you feel, leaning against the patient's face with a neck, his exhalation? Can you hear him breathing?

If there is no breathing, an urgent need to start cardiopulmonary resuscitation (artificial respiration and chest compressions).

Line up a dish or towel for vomit. When vomiting, turn and hold your head down to deflect vomit and prevent inhalation. Use your finger to cleanse your mouth of vomit residues.

Oxygen access:

Unbutton the collar, belt and all other items of clothing that tighten the body and impair the blood supply. Remove the shoes from the patient. Ask to open a window for fresh air. Keep the lower jaw constantly so that the patient's mouth is constantly open - this will improve the flow of oxygen. If you have a medical aerosol can with oxygen and mask (sold in pharmacies), use it.

We control blood pressure:

In most cases, blood pressure rises in the acute phase of a stroke. On the one hand, the increase in pressure is a compensatory means to improve the blood supply to the brain. On the other hand, high blood pressure increases the risk of recurrent stroke and worsening of the patient's condition. If you can monitor the patient's blood pressure with a tonometer, then it is recommended to maintain the following blood pressure values ​​in a patient with an acute stroke:
in patients with essential hypertension: 180 / 100-105 mm Hg
in patients without hypertension: 160-180 / 90-100 mm Hg
It is strictly forbidden to reduce pressure with medicinal products without a doctor!

Simple manipulations with ice (snow) and heating pads will help lower your blood pressure a little:
Cold (ice) compresses should be applied to the area sino-carotid node(under the lower jaw on the side of the trachea). The impact on the sino-carotid node leads to a decrease in blood pressure and expansion of blood vessels. If there is nowhere to take ice or snow, use a damp towel to cool the reflexogenic zone. Several finger taps on the eyeballs will also help to reduce pressure.
At the same time, you need to apply a hot heating pad to your feet or rub your feet with mustard.
You should not cover the patient with a blanket: cooling the body leads to the centralization of blood circulation, which means improved blood supply to the heart, lungs and brain, which is necessary in stroke.

It is impossible to apply ice (cold) to the head, the back of the head - this can impair the blood supply to the brain!

4. Reflexotherapy and micro bloodletting in acute stroke*

With a stroke actively massaged with force for 3-5 minutes (rubbed, pressed, punctured with a nail), or burned with a cigarette (from a distance of several cm) point GI3 san-jian and point V62 Shen-May(massage only).

With loss of consciousness, coma actively massaged with force for 3-5 minutes (rubbed, pressed, punctured with a nail) point GI4 he-gu: first on the healthy side of the body, then on the side affected by a stroke.

Then pass to the effect (strong massage for 3-5 minutes) on the points sequentially VG20 bai-hui(located along the midline of the head at the intersection with the line from the top of the ears) and pressing with a fingernail on the point VG26 ren-chzhong, which is located in the upper 1/3 of the nasolabial fold under the nasal septum.

Further an emergency puncture is performed with a sterile needle from a conventional syringe of special non-meridian points PC86 shih-hsuan, which are located in the middle of the tip of each finger, 3 mm from the free edge of the nail, with squeezing a drop of blood from each finger, can reduce the severity of consequences in acute stroke. Begin with a puncture of the IV and V fingers.

With an increase in blood pressure points are additionally punctured PC86 II and III fingers of each hand.

If it is difficult to remember all the acupuncture points during the institute, then remember at least about the injection of a syringe with a needle of all fingers and earlobes.

Fast care for a stroke and proper therapy can not only save a person's life, but also reduce to a minimum the consequences of an attack, which in the future affects the quality of his life. Unfortunately, the consequences of the disease are often very serious, since the people around them do not recognize the disease in time, and the patient does not receive treatment. Therefore, in order to be able to provide first aid in case of impaired blood flow to the brain, it is necessary to study its signs well and find out what actions should be taken.

What to do with a stroke: emergency care and actions

Most often, impaired blood circulation in the brain occurs in people aged 45 years and older. The risk group includes patients with diabetes mellitus, hypertension, arrhythmia and blood clotting disorders. Symptoms such as:

  • headaches;
  • dizziness;
  • attacks of sudden drowsiness, weakness, or tiredness;
  • increased blood pressure;
  • sensation of heat, followed by a sensation of cold.

If a person experiences such ailments, one should not delay time, but consult a doctor who will diagnose and prescribe a course of treatment.

Given that the effectiveness of therapy depends on how quickly the violation of cerebral blood flow was detected and first aid for stroke was provided, you should be aware of all the signs of the disease.

If a person has impaired cerebral circulation, he will experience the following symptoms:

  • Strong headache;
  • feeling weak;
  • dizziness;
  • numbness of the limbs on one side;
  • numbness of half of the face;
  • skewed face;
  • sudden loss of balance, often combined with nausea or fainting;
  • deterioration in the quality of speech (there may be a feeling of "porridge in the mouth");
  • sudden epileptic seizure;
  • a sharp deterioration in vision, double vision;
  • loss of familiar skills such as reading or writing.

With minimal suspicion of a circulatory disorder in the brain, the patient should be asked to undergo a simple test. Ask him to smile, say "thirty-three", stretch out his arms and freeze in this position for a few seconds. If the patient cannot cope with at least one of the tasks, you need to quickly call an ambulance. At the same time, it is necessary to insist that not an ordinary team of doctors arrive, but a specialized neurological team.

First aid before ambulance arrives

A stroke is an urgent condition, so there is no time to hesitate. Waiting for the arrival of the ambulance team, which must deliver the patient to a specialized medical institution, it is required to alleviate the person's situation by providing first aid.

First you need to check the patient's breathing. Vomiting is considered one of the symptoms of cerebral hemorrhage, so vomit can interfere with normal breathing. If respiratory disorders are detected, the airways are released - the patient is placed on his side and the oral cavity is cleaned by wrapping his finger in a handkerchief or a piece of gauze.

If there is a tonometer and a glucometer, the patient's blood pressure is measured and the amount of sugar in the blood is determined. The time of the measurements and the results are recorded, and then reported to the arrived team of doctors.

It is very important to know exactly when the patient had a stroke. Having found a person who has signs of a stroke, you need to remember or try to find out who and when last saw the patient in a normal state.

First aid for stroke does not involve taking medications that lower blood pressure. In the first hours after a failure in the cerebral blood supply, an increased level of pressure is a necessary norm, which helps the brain to adapt to what has happened.

A person who is suspected of having a stroke is forbidden to feed or drink, as the food eaten or the water drunk can worsen the patient's condition.

If a person, having lost consciousness, fell and ended up on the floor, he can be moved by changing the position of the body. There is an opinion that a person who has impaired blood supply to the brain is prohibited from moving. However, this statement is a myth that does not correspond to reality.

The patient needs to be laid so that his head, as well as the upper body, are in an elevated state. In order to make breathing easier, they unbutton their clothes or take off the interfering thing. In the room where the patient lies, it is necessary to ensure the flow of air from the street by opening a window or window.

One of the symptoms of impaired cerebral blood flow is an epileptic seizure, in which the patient loses consciousness. A few seconds after the loss of consciousness, the patient begins convulsive muscle contractions throughout the body, lasting several minutes. Convulsive seizures are single or follow one after another. If a person has epileptic seizures, you need to protect him from hitting the floor, walls or pieces of furniture with a pillow or other soft thing tucked under his head. The person's head is held, wiping the foam coming from the mouth with a towel or cloth, in order to prevent it from entering the respiratory tract. So that during a seizure the patient does not injure himself by biting his tongue, a small stick or other strong oblong object, wrapped in cloth in several layers, must be inserted between the teeth.

During a seizure, no attempt is made to hold the patient's limbs by force or to unclench the fingers, which have been clenched by a convulsion. These actions can provoke a worsening of the seizure and the emergence of the risk of accidental fracture or dislocation. It is also forbidden to try to bring the patient to consciousness with the help of ammonia, as it can cause respiratory arrest. In addition, if the patient begins to have convulsions, there is a risk of spilling ammonia and causing a chemical burn of tissues.

A person who has epileptic seizures cannot be transferred from place to place.

If the patient's pulse ceases to be felt, cardiac arrest occurs and respiratory activity stops, resuscitation procedures are immediately started. The patient is given chest compressions and mouth-to-nose or mouth-to-mouth resuscitation prior to the arrival of the medical team or the recovery of lung function.

PMP

The arriving ambulance team must transport the patient to a specialized medical institution, where he will be provided with treatment. After a person who has suffered a hemorrhage is hospitalized, you need to make sure that the doctors have performed all the necessary manipulations. The patient must undergo a computed tomography of the brain. Without conducting tomography, it is impossible to determine exactly whether the patient had a hemorrhage or not, the type of stroke, and which parts of the brain were damaged.

Also, patients need to do laboratory tests, in particular, to determine the level of blood oxygen saturation. If a stroke is suspected, a cardiogram is also done and blood pressure is measured.

There are two forms of the disease:

  • hemorrhagic (considered the most dangerous type of disease in which there is a serious threat to life), is a cerebral hemorrhage, during which the wall of an artery is torn;
  • ischemic (the most common form of the disease), in which damage to the brain occurs due to a violation of the blood supply, causing a lack of oxygen.

Stroke forms have similar symptoms and different mechanisms of development, but they require different methods of treatment. In the case when, as a result of computed tomography, a hemorrhagic stroke was not detected in a person, it is necessary to carry out magnetic resonance imaging next, which, in case of ischemic stroke, allows to obtain the maximum amount of information. If there is time, a more detailed examination of the patient is carried out, an ultrasound scan of the vessels of the brain and angiography are performed. Based on the results of the examination, the patient is assigned a treatment program.

If a person has an ischemic stroke, the patient is prescribed thrombolytic therapy. The emergency method can significantly reduce and even eliminate the consequences of hemorrhage, which significantly increases the possibility of complete recovery. The patient is injected intravenously with a drug that dissolves the blood clot that blocks the cerebral artery. However, thrombolytic therapy is possible only within the first three hours after the hemorrhage. In addition, this method of treatment can only be used in a specialized medical institution.

The technique used for ischemic stroke can significantly aggravate the condition of a person who has had a hemorrhagic stroke, for the treatment of which surgery is often required.

Knowledge of the first symptoms of cerebral blood supply disorders and the ability to recognize the disease allows timely provision of timely medical care to the patient. Modern methods of medicine and treatment technologies make it possible to effectively fight the disease, so a person who has suffered a stroke after rehabilitation has every chance to recover and return to a normal lifestyle.

Prehospital exposure is considered one of the main in the normalization of the condition in stroke. According to studies, at the stage before a person is transported to a hospital, up to 20% of all patients die.

The rest, with untimely or incorrect assistance, risk becoming disabled, with persistent neurological deficits (about 40% more).

Primary pre-medical activities at home and on the street acquire a very "creative" character, not even the most complete guide can take into account all the nuances.

Theory is often at odds with practice. Therefore, the lists and algorithms are of an approximate nature, indicate the necessary actions and strict prohibitions, which must be adhered to.

First aid for a stroke before the arrival of an ambulance is not intended to cure a person and prevent him from being transported to a hospital. Even a doctor in the field is not capable of this.

It is required to stabilize the condition, to minimize the risks of death and disability due to the lack of outside assistance. With a competent approach, there is every chance to achieve a solution to this goal, albeit with difficulty.

The classic scheme includes a large group of actions and a slightly smaller number of hard prohibitions. Help for hemorrhagic and ischemic stroke will be the same.

You need to calm down, stabilize the emotional background

People who have no experience in first aid or if they have minimal experience are especially nervous.

A stressful situation leads to confusion of activities, a person fusses, moves a lot, runs, but everything is useless, since there is no purposefulness and this is a chaotic work.

This means that the terms of first aid increase, the effectiveness of measures decreases, and the victim's chances of a favorable outcome and preservation of the basic functions of the central nervous system, and even life, decrease.

Call an ambulance

A task of paramount importance at the slightest suspicion of a stroke. You can do very little on your own. When you call, it is imperative to tell the dispatcher about the alleged diagnosis, briefly and clearly describe the situation.

By downplaying, a person risks making a fatal mistake. Ambulance crews are not fully staffed, and if there are enough personnel, few cars travel around the city, so doctors are forced to rank and sort cases by urgency.

It is important that the victim is on the priority list, then the team will arrive much faster. Otherwise, there is a risk of not waiting for doctors in the future for several hours or even more.

Assess objective signs, body functions that play a key role

The cardiovascular system is examined by heart rate (pulse in the carotid artery) and pressure level. Both indicators fall on the background of a stroke, or slightly increase and only then "sag" to the minimum marks, because the body is in a stressful state.

Tachypnea (enlargement) develops more often, decrease, superficiality, inability to listen normally indicate possible damage to the respiratory center in the brain stem.

Then there are other signs. Like a deep faint. The simplest reflexes are also necessarily evaluated. Like the reaction of the pupils to light. A decrease in the speed of response is a negative point.

Identify objective signs of stroke

They are represented by neurological deficits of varying severity.

For example, a skewed face due to paralysis of facial muscles from the opposite localization of the lesion to the side, inability to control the limbs, deep loss of consciousness, speech dysfunction, convulsions.

These are nonspecific signs, therefore, it will not be possible to say anything precise right off the bat. Need diagnostics in a hospital and then only after the provision of high-quality hospital care.

Related materials:

  • Signs of a microstroke in u and u

Interview the patient for complaints

If the person is conscious. On the one hand, this will allow you to better orient yourself in the situation, on the other hand, it will help to reduce the time upon arrival of doctors.

They will start asking the same questions and only then will they transport the patient to the hospital. Better to prevent such an unreasonable waste of time.

Complaints may include headaches, vertigo (the world goes around in front of your eyes), nausea, a feeling of running creeps, numbness of the limbs, the whole body, confusion, weakness, drowsiness, discomfort when swallowing, feeling of a lump in the throat (not always).

Attention:

It is important to interview the patient as shortly as possible, so as not to overload him with information and not force him to think intensively. It can be dangerous in this state.

Provide a person with complete peace

Eliminate the impact of intense noise, light stimuli, talk less with the victim, do not allow movement.

Lay the patient on their back

The head should be slightly above the level of the body, as well as the body itself should be raised. This will ensure adequate blood flow to the brain, prevent uneven hemodynamics, when the limbs will receive more nutrients and oxygen than the cerebral structures.

The pose can be changed if the victim is unconscious. There are two options.

  • Leave in this position and just turn your head a little to one side. This will prevent the aspiration of gastric contents during vomiting, and therefore exclude asphyxia and death.
  • The second possible option is to lay it on one side. The effect will be about the same. Therefore, the issue is decided at the discretion of the provider of emergency assistance.

The second option is considered safer in terms of preventing aspiration.

Calm the person

The algorithm of actions includes the normalization of the emotional and mental background. Stroke is the hardest stress from any point of view. Therefore, the patient's normal reaction is fear, panic.

Psychomotor agitation is possible. It is necessary to explain to the patient the essence of the condition, without going into details, to tell about the positive prospects of treatment and the possibility of full recovery.

Provide a normal supply of fresh air

If the patient is on the street, there will be no problems. In the room, it is worth opening a window or window. This will partially compensate for hypoxia (oxygen starvation of the brain) so as not to provoke further deterioration.

Continuous condition monitoring

It is necessary to closely monitor breathing and cardiac activity. With the development of deviations, resuscitation measures are carried out. How exactly?

Indirect cardiac massage during cardiac arrest (). It is a way to restore the work of a muscular organ.

It is being carried out urgently. You need to put an open palm on the center of the chest, on top of the other hand.

Rhythmically push the area to a depth of several centimeters at a speed of 80-100 movements per minute.

Providing urgent care is physically challenging. Therefore, the ideal option is that every 1-2 minutes a person is replaced by another who will carry out the same events with fresh forces and so on in a circle.

If medical workers do not arrive within 10 minutes and it is possible to independently transport the victim to the hospital, do not hesitate.

Because with a stroke, the count really goes on for minutes. The delay reduces the chances of survival or recovery of higher nervous activity without complications.

Upon the arrival of the doctors, all activities are stopped. It is necessary again to briefly describe the situation in a nutshell. If necessary, the patient is escorted to the hospital.

The list provided is indicative. This is not a rigid algorithm, not a sequence.

In real conditions, it is sometimes necessary to perform several actions at once in order to achieve a result. Therefore, first aid has a lot of improvisation.

What not to do

As for the prohibitions, they are tough. They cannot be violated or the patient will suffer even more. What exactly should be avoided:

  • The position of the body in which the head is below the level of the body. There will be a catastrophic violation of hemodynamics, critical ischemia will develop. The stroke will get worse. The patient will die.
  • Any physical activity is excluded. The person should lie and move as little as possible. Stroke is not always a critical condition in which the patient lies prone and cannot walk or speak.

Much depends on the localization of destruction, the rate of development and intensity of neurological deficits, general health and resistance to negative factors.

Therefore, you need to strictly monitor any activity and stop it. Spontaneous deterioration is possible with imaginary well-being. Doctors should understand the issue.

  • Stroke emergency care eliminates any unknown drugs. If a person discussed the possibility of a condition with his doctor, it is necessary to clarify what medications he is taking, whether there are any recommendations on this score, only then give pills. Insofar as the victim himself is unable to drink them for obvious reasons.

Amateur performance is strictly excluded. In exceptional cases, you can resort to injections of cerebrovascular drugs, such as "Piracetam", "Actovegin".

But for this you must be completely sure that the stroke is not. This means there is no hemorrhage.

And that he is not, so as not to provoke a deterioration. It is impossible to understand this by eye, therefore it is definitely not recommended to take risks.

  • You can not eat, drink a lot of fluids. With loss of consciousness, profuse vomiting will occur, which can lead to aspiration (penetration of masses from the gastrointestinal tract into the respiratory tract).
  • You can not wash, take a bath, go to the shower. Contrary to possible belief, changing the temperature does not have a beneficial effect on the vessels. This is stress for the entire system.

In no case should you rely on your own strength. The task of the first aid is to stabilize the condition before the arrival of doctors. It does not replace transportation to the hospital and full-fledged intensive care, hospital care.

If these points are not followed, the first actions in stroke risk becoming the last.

What to do if you lose consciousness

The violation indicates a severe stroke condition, severe. Negative prognostic sign.

It is necessary to turn the patient on the side, as already mentioned, or slightly change the position of the head. To prevent vomiting from entering the respiratory tract.

Beating a person on the cheeks, shouting loudly, shaking them by the shoulders is not just contraindicated, but also stupid from the standpoint of common sense. It is impossible to bring a person out of fainting in this way, but it is quite possible to damage his health.

With the development of loss of consciousness, it is especially important to monitor the state of the person. Evaluate the heart rate, the safety of normal respiratory activity.

Because cerebral edema, disruption of the trunk and death are likely. At the first deviations, resuscitation is carried out as far as one's own strengths allow.

With convulsions

Painful voluntary muscle spasms occur against the background of damage to the parietal, temporal, and frontal lobes of the brain. They are extremely uncomfortable for the patient.

It is impossible to radically influence the state of affairs, the only thing worth recommending is, after the paroxysm (attack), when it comes to an end, to turn the patient's head to one side.

The tongue in hypertonicity cannot sink. And with total relaxation of the muscles - this is quite possible and very dangerous.

Tonic-clonic seizures, like other abnormalities, develop not only against the background of a stroke.

They are possible with brain tumors, idiopathic, cryptogenic or idle undiagnosed epilepsy, neuroinfections, and injuries.

Therefore, it is impossible to differentiate states on our own. It happens that the reason for the situation is not what others think about. Including doctors. Diagnostics required.

Before the arrival of specialists, it is assumed that we are talking about a stroke, since the symptoms are almost indistinguishable.

With cardiac arrest

Asystole is an acute emergency. It may well turn out to be irreversible, because the chances of recovery are not present in all cases. But it is forbidden to sit idly by.

In many situations, unfortunately, we are talking about damage to the brain stem. Not necessarily primary. The focus can be generally in the opposite part of the cerebral structures.

But this is a closed system that exists in extremely cramped conditions. Therefore, intracranial pressure, the amount of cerebrospinal fluid increases. This means that it is possible to indirectly damage the trunk with the development of catastrophic symptoms.

With the destruction of the subcortical structures, the chances of "starting" the heart are minimal. There is no stimulation of the work of the muscular organ by the central nervous system. In such a situation, it is almost impossible to help.

The basis of resuscitation is an indirect cardiac massage (the technique is presented above). You need to make about 80-120 movements per minute, the chest is pushed 5-6 centimeters.

It will take a lot of effort to achieve the effect. This requires good physical fitness, but quickly becomes exhausting. It is quite possible that the maximum that a person can do is 30-80 seconds.

Many do not have experience in doing this, therefore clinical guidelines do not advise resorting to the technique without the presence of skill and psychological readiness.

The restoration of cardiac activity can be considered a conditional success. But at any time, a relapse is likely. It is worth closely monitoring the patient.

Outdoor activities

Home first aid for stroke requires less effort, because there are additional risks outside the walls. There are not many fundamental differences.

What are we talking about:

  • Perhaps a violation of health, falling, loss of consciousness in a dangerous place. For example, on a busy unregulated crossing. A person should be transported as quickly as possible away from risks, to safety
  • In the cold season, the victim is transferred to the room.
  • You should loosen the collar, remove body jewelry. To avoid compression of the carotid sinus and carotid artery. Otherwise, there will be an even greater deterioration in the trophism of the brain.
  • If possible, you need to involve in first aid and other people who could temporarily change. For example, if you need a heart massage. Perhaps someone will agree to transport the patient to the hospital if the ambulance is late or does not arrive at all.
  • It is imperative that you call the person's relatives so that they know about what happened. After the ambulance arrives, tell about the transfer of the victim to the hospital (hospital number).

First aid for stroke is a difficult task. It is not easy to carry out all the actions correctly, even with a medical education.

But with proper delivery, the patient has every chance of recovering, preserving life and health. It's about the key point along with the actions of doctors.

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

Date of publication of the article: 25.11.2016

Date the article was updated: 05/25/2019

First aid measures for 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 rendering. According to foreign and domestic experts, the optimal time for delivering a patient to a hospital is 3 hours from the moment of illness (the earlier, the better).

What to do with a stroke in a person in the first place

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

  1. Do not panic!!!
  2. Assess the general condition of the patient: consciousness, breathing, heartbeat, pressure.
  3. Identify the obvious signs of a stroke: unilateral paralysis of the arm and leg, a distorted face, speech impairment, lack of consciousness, seizures.
  4. Call an ambulance by phone 103!
  5. Find out the circumstances of the illness (as briefly as possible).
  6. Provide resuscitation measures (artificial respiration, cardiac massage), but only if necessary (lack of breathing, palpitations and wide pupils).
  7. Lay the patient correctly - on his back or on one side, or with the head and body slightly raised, or strictly horizontally.
  8. Provide conditions for good oxygen access to the lungs and blood circulation throughout the body.
  9. Monitor the patient's condition.
  10. 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 given algorithm. In case of critical disorders of the patient's condition, one has to act very quickly, performing several actions at the same time. Therefore, if possible, 2-3 people should be involved in providing assistance. In any case, following the algorithm, you can save the patient's life and improve the prognosis for recovery.

Detailed description of all emergency steps

Each activity that includes first aid for a stroke requires correct execution. It is very important to stick to the subtleties, as any "small" 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, smoothly and consistently. Fear, vanity, haste, unnecessary movements lengthen the time for rendering assistance.

Calm the sick person

Every conscious person with a stroke is necessarily worried. After all, this disease is sudden, so the stress response of the body cannot be avoided. Excitement will aggravate the condition of the brain. Try to calm the patient down, convince him that everything is not so scary, this happens and the 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. It will take less than a minute. While the ambulance is on the way, you will provide emergency assistance.

Assess the general condition

First of all, pay attention to:

  • Consciousness: its complete absence or any degree of dullness (lethargy, drowsiness) is a sign of a severe stroke. Mild forms are not accompanied by impaired consciousness.
  • Breathing: it may not be disturbed, but it may be absent, intermittent, noisy, frequent or rare. It is possible to do artificial respiration only in the complete absence of respiratory movements.
  • Pulse and palpitations: They can be heard well, be quick, irregular, or weakened. But only if they are not defined at all, you can do it.

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;
  • skewed face (ask to smile, bared teeth, stick out your tongue);
  • violation or lack of speech (ask to say something);
  • weakness, numbness of the arms and legs on one side, or their complete immobility (ask them to raise their hands in front of you);
  • visual impairment;
  • impaired coordination of movements.

Lack of consciousness or any combination of the listed signs is a high likelihood of a stroke.

Correct position of the patient

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


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

If you have seizures

Convulsive syndrome in the form of 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 the side with your head turned to prevent saliva and vomit from entering the respiratory tract.
  • If you can, place any cloth-wrapped object between your jaws. This is rarely done, so do not make great efforts - they will do more harm than good.
    Do not try to open your jaws with your fingers - this is impossible. Better to grasp the corners of the lower jaw, try to bring it forward.
    Do not insert your fingers into the patient's mouth (risk of injury and loss of finger).
  • Hold the patient in this position until the seizure ends. Be prepared for the recurrence.

On the importance of the circumstances of the disease

If possible, find out exactly how the person got sick. This is very important, as some of the symptoms of a stroke can also 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, affecting vital centers, or accompanied by severe cerebral edema, proceeds with signs of clinical death:

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

Follow these steps:

  1. Lay the person on their back on a firm surface.
  2. Turn your head to one side, use your fingers to free the oral cavity from mucus and foreign objects (dentures, blood clots).
  3. Throw your head back well.
  4. Grab the corners of the lower jaw with 2–5 fingers of both hands, pushing it forward, at the same time slightly open the patient's mouth with your thumbs.
  5. Artificial respiration: cover the patient's lips with any tissue, and with your lips firmly pressed, take two deep breaths (mouth-to-mouth method).
  6. Heart massage: place your right hand on your left (or vice versa) with your fingers locked. Putting your lower palm to the junction point of the patient's lower and middle sternum, press on the chest (about 100 per minute). Every 30 movements should be alternated 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 his own. If delivery to the hospital is delayed, the following drugs (preferably in the form of intravenous injections) can help support brain cells at home:

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

Stroke self help

The ability to provide stroke care to oneself is limited. In 80–85% of cases, 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 symptoms that resemble a stroke:

  1. take a horizontal position with a raised head end;
  2. tell someone that you feel bad;
  3. call an ambulance (103);
  4. adhere to strict bed rest, do not worry and do not move unnecessarily;
  5. free the chest and neck from compressive objects.

Helping yourself with a stroke

If the stroke is ischemic

Ideally, even first aid for stroke should take into account the type of disease. Most likely ischemic stroke if:

  • occurred in the morning or at night at rest;
  • the patient's condition is moderately disturbed, consciousness is preserved;
  • signs of speech impairment, weakness of the right or left extremities, facial distortion are expressed;
  • no seizures.

For such patients, first aid is provided according to the classical algorithm described above.

If the stroke is hemorrhagic

Symptoms in favor:

  • arose abruptly 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:

  1. The position is strictly with the raised head end (except for convulsions or resuscitation).
  2. Applying an ice pack to the head (preferably on the half in which the hemorrhage is suspected - opposite to the immobilized strained 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, someone evaluates the general condition, etc.).
  • Having laid 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 things (in cold weather), massage and rub them.
  • If you have a mobile phone or contacts with relatives, let them know about the incident.

Features of providing assistance at home or in any enclosed space

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

  • Free access of fresh air to the patient: open the window, window, door.
  • Free your chest and neck.
  • If possible, take a blood pressure measurement. If it is increased (more than 150/90 - 160/100 mm Hg), you can give antihypertensive drugs under the tongue (Captopress, Pharmadipin, Metoprolol), lightly press on the solar plexus or closed eyes. If it is lowered, raise your legs, but you cannot lower your head, massage the area of ​​the carotid arteries on the sides of the neck.

How to provide first aid for stroke indoors

First aid effectiveness and prognosis

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

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

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