Emergency care for stroke: characteristic symptoms of brain damage and rules for providing first aid. Emergency care for a stroke: characteristic symptoms of brain damage and rules for providing first aid Emergency care for ischemic stroke

These are all names for the same pathology) is a dangerous disease that very often leads to death or to a deep disability of the patient.

Treatment of such patients is carried out only in the neurological intensive care unit, but the first (emergency) care should be provided at the prehospital stage, and often the solution of this problem falls on the shoulders of people who have nothing to do with medicine.

In the same way as rehabilitation - the first stages are carried out in specialized medical institutions, and after that the patient is discharged home, under the supervision of a local doctor and his relatives. It is on their efforts and diligence, as well as on the willpower of the patient, that the prognosis for further recovery depends.

Depending on their pathogenetic mechanisms, strokes are ischemic and. If in the first case the damage to the nervous tissue is provoked by circulatory failure, then in the second case there is a hemorrhage and a vessel that feeds a certain part of the brain. This feature determines the tactics of patient management - the stroke care algorithm in each of the above cases will be completely different. First aid for stroke does not have any special differences, and specialized therapy can be prescribed only after a set of diagnostic measures.

Please note that any treatment is prescribed only by a neurologist or therapist. Even the therapy that will be carried out not at home, but in the department, is selected by the doctor purely on an individual basis, and those people who do not understand medicine should not interfere in any way with the ongoing treatment. Their only function is to constantly monitor the regularity of taking medications by patients.

Pay attention to one more feature - the article lists only groups of drugs and some names. The tactics of patient management, as well as the frequency of taking medications, can only be determined by the attending physician.

Goals and stages of treatment

All stroke treatment can be divided into several stages:

1. Help at the pre-hospital stage. Often, it must be provided even before the arrival of the ambulance team, since in this situation almost every minute counts. The fulfillment of this task is feasible even for those people who are not related to medicine. The purpose of all this is to control the vital functions of a person (pulse, respiration, blood pressure level) and, if necessary, introduce or start resuscitation measures. The purpose of this stage is to bring the patient to the hospital of the intensive care unit. It is necessary to focus on the importance of providing medical care at the prehospital stage. Regardless of which side of the cerebral hemispheres is affected (even if there is necrosis in the region of the right temporal gyrus, which is characterized by the most severe course), all the same, with a competently and timely intervention, the prognosis of the disease will be much more optimistic.
2. Emergency care in general (ideally cardiological) resuscitation. In the event that a person is diagnosed with acute insufficiency of the ischemic type, the main component of treatment will be thrombolytic. Due to the introduction of drugs that contribute to the dissolution of blood clots, it is often possible to restore blood circulation in the ischemic area as soon as possible. Sometimes these drugs are administered even with transient ischemic attack. Then it is generally possible to avoid organic damage.
3. Rehabilitation in the conditions of the department of neurology, and then in a special center. This set of measures is aimed at stopping neurological symptoms, as well as restoring the patient's basic life skills that he needs for self-care. This includes walking, and articulation (), and fine motor skills of the hands. A complex of physiotherapy exercises, physiotherapy using a variety of techniques is carried out. In fact, the patient starts life from scratch - he learns to read, write, talk, walk, remember basic information (first name, last name, age, relatives' names, and so on).
4. Treatment on an outpatient basis. After the rehabilitation course is completed, the patient is sent home for treatment under the supervision of a local general practitioner and a neuropathologist. The purpose of this stage is further stabilization of the patient's condition and prevention of recurrence of acute circulatory failure. On an outpatient basis, a person who has had a stroke takes drugs whose action is aimed at stabilizing the level of blood pressure (angiotensin-converting enzyme inhibitors, beta-blockers and diuretics), as well as those drugs whose action is aimed at improving the trophism of the nervous tissue (piracetam and actovegin). In other words, there is a further recovery of the patient after a cardiovascular accident.

Types of stroke

Depending on the pathogenetic mechanism, strokes are usually divided into two types:

1. - there is necrosis of a certain part of the brain due to the fact that it does not receive blood with the nutrients and oxygen necessary for metabolism.
2. Hemorrhagic - necrosis also occurs in the same way, but in this situation it will be associated with hemorrhage. In turn, this type of acute cerebrovascular insufficiency is usually divided into two more subspecies - subarachnoid hemorrhage and stroke itself. In the first case, there is a lesion of the cerebral cortex and subcortical structures (in other words, a hematoma of the subarachnoid space occurs), and in a classic hemorrhagic stroke, the brain parenchyma is damaged (the hemorrhage is located in the medulla oblongata, pons or cerebellum).

A transient ischemic attack is not a stroke per se. Yes, the occurrence of this disease leads to the fact that there is a severe headache, and regardless of the age of the patient, however, the formation of a focus of necrosis does not occur.

That is, the problem is pathophysiological in nature, and not histological, which means that its treatment will be easier. But all the same, hospitalization in the City Clinical Hospital (City Clinical Hospital) will be necessary.

What is most interesting, this disease is very often observed - even at the age of 21, boys and girls (mainly suffering from VVD) end up in the neurological department with such a diagnosis. A typical picture - the man was nervous, dizzy, pressure rose, and he fell, but there are no signs of a stroke on CT scan. Conclusion - he has a TIA, a transient ischemic attack.

Ischemic stroke (brain infarction)

In this case, the appointment of drugs is justified, the action of which is aimed at normalizing blood flow by splitting blood clots that obstruct the vessel that supplies blood to a certain area of ​​the brain. Another equally important area of ​​therapy is neuroprotection. The most commonly used neuroprotector is actovegin, which helps to restore areas affected by the necrotic process.

Hemorrhagic stroke (intracerebral hematoma)

In this case, there is a most dangerous disease that puts the future life of the patient in question. For treatment, hemostatics (dicinone, etamsylate, aminocaproic acid) and diuretics (loop and osmotic) are used. The first drugs help slow down blood circulation in the area of ​​​​the hematoma, and the latter help to remove fluid from the body. It is very difficult to cure this type of stroke, especially if. For it to happen, it will be enough to burst a small vessel.

Most likely, the patient will be lying down until the end of his life, and no medicine will help him return to his former life, there will be no way to cure him.

Transient ischemic attack (TIA) or microstroke

In the absence of a focus of necrosis, it is recommended to prescribe medications that allow you to stop vasospasm and intervertebral pain in the cervical region (if any) - a combination of NSAIDs and antispasmodics is best suited. In addition, the technique of acupuncture is also justified to prevent relapses.

First signs and symptoms

Regardless of whether a person has a right-sided or left-sided stroke, the following symptoms will be characteristic:

1. increased blood pressure;
2. violation of consciousness and speech;
3. facial distortions.

Their duration may vary, and it is very important to recognize the onset of the manifestation of the disease in time.

Important!

This is interesting!

One of the charlatans who brought a lot of harm with his “works” is “Professor” Neumyvakin - in fact, this person never had and never has anything to do with medicine, but all his life he worked as an ordinary journalist, moreover, in the “yellow press” ". According to his "theory", all diseases that a person has can be easily defeated using hydrogen peroxide (including the acute period of a stroke). Allegedly, peroxide somehow “miraculously” affects the spine, and this allows you to correct the situation as soon as possible. In fact, hydrogen peroxide, like a wonderful diet with dietary supplements, will not help with a stroke. Homeopathy is a similar deception - it is not medicine in fact, but a paramedical direction that has no evidence base.

Collection of mistletoe and sophora

When paralyzing the patient and eliminating the consequences of stroke, it is recommended to use this drug, prepared from mistletoe and sophora. Here is the prescription:

1. take 100 g of grass of both plants;
2. pour them with 1 liter of boiling water and insist for a day;
3. drink 1 glass once a day.

White step tincture

For home treatment of ischemic stroke (but not for emergencies) and neurological insufficiency, it is recommended to use a tincture of white foot, which is popularly called the "needle". Prepare it as follows:

1. 200 g of grass is poured into 400 ml of ethyl alcohol 96%.
2. The resulting composition is infused for a day.
3. Take a teaspoon twice a day.

Celandine against stroke

Neurology, even if the patient has a disability and with paralysis, can be treated with simple folk remedies (of course, in combination with prescribed cardiological medications so that cardiac arrest does not occur). A tincture of celandine is prepared for alcohol in a ratio of 1 to 10, taken 5 to twice a day, a weekly course.

Pine cones against stroke

The indication for the use of this remedy is the elimination of the consequences of a cerebral infarction. A phytopreparation cannot completely help get rid of them, but it is elementary to help in the overall recovery process.

To prepare it, it will be enough to take 10-15, and pour them with 1 liter of boiling water. After the resulting infusion is filtered, it will need to be drunk in a glass three times a day.

Other

Regardless of the stage of rehabilitation the patient is at, he will be shown not only physical education, but also physiotherapy using special preparations (such as lidaza and bischofite).

Especially effective is the use of electrophoresis with these agents after surgical treatment.

Forecasts and prevention

To overcome such an ailment as acute cerebrovascular insufficiency (or rather, its consequences), it is necessary to ensure effective prevention of the occurrence of hypertensive crises. Disease can be defeated only with the systematic use of medications - this approach is also true in the case of a stroke.

In other words, the patient will have to take antihypertensive drugs for life - ACE inhibitors, beta-blockers and diuretics. The choice of treatment will be made by a general practitioner or cardiologist.

Another complication that is quite common in stroke patients is depression. For its relief, it is indicated to use glycine, sedaxen or sedavit (in combination with nootropics).

Algorithm of first aid for stroke: to a stranger, to yourself, on the street and at home

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

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

What should be done in case of a stroke in a person in the first place

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

1. Do not panic.
2. Assess the general condition of the patient: consciousness, breathing, heartbeat, pressure.
3. Identify clear signs of a stroke: unilateral paralysis of the arm and leg, distorted face, impaired speech, unconsciousness, convulsions.
4. Call an ambulance by calling 103!
5. Find out the circumstances of the illness (if possible, briefly).
6. Provide resuscitation (artificial respiration, cardiac massage), but only if they are necessary (lack of breathing, heartbeat and dilated pupils).
7. Correctly lay the patient - on his back or side, either with a slightly raised head and torso, or strictly horizontally.
8. Provide conditions for good access of oxygen 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 above algorithm. In case of critical violations of the patient's condition, it is necessary to act very quickly, performing several actions at the same time. Therefore, whenever possible, 2-3 people should be involved in providing assistance. In any case, following the algorithm, you can save the life of the patient and improve the prognosis for recovery.

Detailed description of all emergency steps

Each event that includes first aid for a stroke requires proper implementation. It is very important to stick to the subtleties, since any "little thing" 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, coherently and consistently. Fear, fuss, haste, unnecessary movements lengthen the time to provide assistance.

Calm down the patient

Every conscious person with a stroke is sure to worry. After all, this disease is sudden, so the stress reaction of the body cannot be avoided. Anxiety will aggravate the condition of the brain. Try to calm the patient, convince him that everything is not so scary, this happens and 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. This will take no more than a minute. While the ambulance is on the way, you will provide emergency care.

Assess the general condition

First of all, pay attention to:

• Consciousness: its complete absence or any degree of stupefaction (lethargy, drowsiness) is a sign of a severe stroke. Mild forms are not accompanied by impaired consciousness.
• Respiration: it may be normal, or it may be absent, intermittent, noisy, frequent or infrequent. Artificial respiration can be done only in the complete absence of respiratory movements.
• Pulse and heartbeat: they can be heard well, be rapid, arrhythmic or weakened. But only if they are not determined at all, you can do an indirect heart massage.

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

Lack of consciousness or any combination of these signs - a high probability of a stroke.

Correct position of the patient

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

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

If there are convulsions

Convulsive syndrome in the form of a 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 one side with your head turned to prevent saliva and vomit from entering your airways.
• If you can, place any object wrapped in cloth between the jaws. It is rarely possible to do this, so do not make great efforts - they will do more harm than good.
  Do not try to spread the jaws with your fingers - this is impossible. Better grab the corners of the lower jaw, try to bring it forward.
  Do not insert your fingers into the patient's mouth (threat of injury and loss of a finger).
• Hold the patient in this position until the seizure ends. Be prepared for the fact that they may repeat.

On the Importance of the Circumstances of the Illness

If possible, find out exactly how the person fell ill. This is very important, as some of the symptoms of a stroke can 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 that affects vital centers, or is accompanied by severe cerebral edema, occurs with signs of clinical death:

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

Follow these steps:

1. Lay the person on their back on a hard surface.
2. Turn your head to one side, use your fingers to free the oral cavity from mucus and foreign objects (prostheses, blood clots).
3. Tilt 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 open the patient's mouth with your thumbs.
5. Artificial respiration: cover the patient's lips with any tissue, and firmly leaning your lips, take two deep breaths (mouth-to-mouth method).
6. Heart massage: place your right hand on top of your left (or vice versa) with your fingers interlocked. Putting the lower palm to the junction of the lower and middle part of the sternum of the patient, perform pressure on the chest (about 100 per minute). Every 30 movements should alternate 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 their own. If delivery to the hospital is delayed, the following drugs help support brain cells at home (preferably in the form of intravenous injections):

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

Self help for stroke

Self-care for stroke is limited. In 80–85%, 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 stroke-like symptoms:

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

If the stroke is ischemic

Ideally, even first aid for a stroke should take into account the type of disease. Ischemic stroke is more likely if:

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

Such patients receive first aid according to the classical algorithm described above.

If the stroke is hemorrhagic

• arose sharply 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 a raised head end (with the exception of convulsions or resuscitation).
2. Applying an ice pack to the head (better to the half in which the hemorrhage is supposed to be - opposite to the immobilized tense 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, and someone assesses the general condition, etc.).
• After laying 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 clothes (in cold weather), massage and rub them.
• If you have a mobile phone or contacts with relatives, let them know about what happened.

Features of providing assistance at home or in any enclosed space

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

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

How to give first aid for a stroke indoors

First aid effectiveness and prognosis

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

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

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

How and how to treat a stroke. What are the consequences after a stroke?

One of the serious diseases that often occur as a result of hypertension, as well as atherosclerosis of the cerebral vessels, is a stroke. Treatment of this disease, subject to its success, can prolong the vital activity of a person. The danger of a stroke lies in the high probability of negative consequences, because. Quite often, the result is a person's disability.

Among the elderly, stroke is the most frequently reported cause of death.

A stroke is characterized by an acute violation of the blood circulation of the cerebral cortex, which results in damage and death of nerve cells.

A stroke is a number of other pathological conditions, including:

• Hemorrhage in the brain;
• brain infarction;
• Subarachnoid hemorrhage.

There are two types of strokes:

They not only differ in origin, but each of them is treated according to a different scheme.

Peculiarity ischemic stroke is a violation of the blood supply to certain areas in the cerebral cortex due to blockage of the artery by a thrombus or atherosclerotic plaque.

Hemorrhagic A stroke occurs when an artery ruptures and bleeds. The cause of this type of disease is a rupture in an enlarged section of the artery due to a congenital pathology of the vessel, called an aneurysm, or a rupture of the artery, the background for which may be high blood pressure.

Types of strokes

Stroke of any kind requires urgent action, medical attention and treatment. The clinical picture with hemorrhage develops so rapidly that the ability to cure the disease is limited by time. Only with the timely provision of qualified assistance, brain damage can be minimized, preventing the manifestation of complications in the future.

Stages of treatment

In order to know how to treat a stroke, it is necessary to represent the sequence of the main stages of this process, which consists of:

Signs of a stroke

In order to recognize the symptoms of a dangerous illness in a person in time, it is necessary to remember them firmly.

The signs of a stroke are:

• sudden weakness;
• Paralysis or partial numbness of the muscles of the face or limbs (most often only on one side);
• Speech disorders;
• visual impairment;
• The appearance of a strong and sharp headache;
• Dizziness;
• Loss of balance and coordination, gait disturbance.

A stroke often takes a person by surprise and at this moment it is very important that the people around show attention and provide first aid.

If you notice a passerby on the street behaving unnaturally, you should not assume that he is drunk until a stroke test is performed according to the following plan:

Steps to take before the ambulance arrives

If there is a suspicion of a stroke that a person can catch at any time - at home or on the street, you should do the following as soon as possible:

Help and first actions of medical workers

In the first minutes after arriving at the location of the affected person from a stroke, the specialists of the ambulance team assess the severity of the patient's condition. Their main task is to transport the patient to a hospital equipped with an intensive care unit.

During transportation:

• Measurements of blood pressure;
• The introduction of drugs that correct the work of the cardiac and respiratory systems.

Patients who:

• Were found in a coma;
• When they have circulatory disorders in the brain in terminal states of various pathologies of internal organs or tumors.

Symptomatic care is provided to patients with such deviations, after which the call is transferred to the clinic.

In which department are they placed with a stroke?

After hospitalization of the victim, treatment of a cerebral stroke in hospital begins with its placement in the intensive care unit, or intensive care. This requires the presence in the clinic of the appropriate unit, equipped with special equipment and qualified personnel.

Patients are examined by a neurologist. A consultation with a neurosurgeon may be required. The treatment regimen, as well as in which department the patient will be located, is determined by the doctor, depending on the established type and severity of the disease. The main tasks of the hospital depend on the type of the disease.

Treatment in a hospital. Preparations.

Treatment for hemorrhagic stroke.

For the treatment of the brain in the development of hemorrhagic stroke, therapy should include a number of specific tasks, these are:

• Elimination of puffiness in brain tissues;
• Decrease in intracranial and arterial pressure;
• Treatment aimed at increasing blood clotting and the density of the vascular walls.

With all the actions of the medical staff, a certain position of the patient on the bed is observed. For this, a functional bed with a raised headboard is used. Ice is placed on the patient's head, and heating pads are placed on the legs. Relaxing the muscles will help ensure the created hamstring. For the same purpose, you can put a roller under your knees.

Drug treatment includes the use of the following drugs for intravenous drip use:

• Magnesium sulphate;
• Dibazol;
• Aminazin;
• Pentamine.

Due to the increased risk of reducing blood clotting, medications that activate thrombosis in the vessels can be administered. This type of therapy should be carried out under the control of a laboratory blood test for a coagulogram.

In the first 2-3 days are prescribed:

• Calcium chloride;
• Vikasol;
• Aminocaproic acid.

In cases where on the third day after a stroke there are pronounced signs of atherosclerosis and subarachnoid hemorrhage, proteolytic enzymes can be prescribed:

One of the effective modern drugs used in the treatment of cerebral stroke is Etamsilat. It allows you to stop blood loss, improve microcirculation in damaged areas of the brain, and normalize vascular permeability. At the same time it serves as an excellent antioxidant.

If cerebral edema has severe meningeal symptoms, a spinal puncture should be performed with caution, in which small amounts of CSF are extracted.

Treatment for ischemic stroke

In the second type of cerebral stroke, the actions of specialists will be aimed at solving the following tasks:

• Improvement of blood supply to tissues;
• Formation of increased resistance to lack of oxygen;
• The introduction of drugs to improve the metabolism in the surviving cells.

The position of the patient in bed should be comfortable, but his head should not be raised as high as it should be done in a hemorrhagic stroke.

At ischemic stroke treatment must necessarily include vasodilators. To a greater extent, collaterals are used, which are auxiliary capillaries that can partially replace natural ones.

For this purpose, the following agents are used in the form of solutions for intravenous drip injection:

• Eufillin;
• No-shpa;
• Papaverine;
• A nicotinic acid;
• Complamin.

used medicine to improve hemodilution - Reopoliglyukin, which improves blood supply by reducing blood clotting.

Medical control and treatment includes a careful measurement of the volume of fluid injected, which in excess can be dangerous by increasing tissue edema. Caution also requires the use of diuretics, especially if there is hypertension.

Along with fibrinolytic agents, anticoagulants are used. In stroke therapy, the important term “golden hour” is used. It serves as an indicator of the maximum effectiveness of drug administration to reduce blood clotting, as well as to predict the disease.

Due to too long transportation to the clinic, it becomes difficult to distinguish between different types of stroke and provide proper treatment assistance, and his the optimal time is lost.

First day ischemic stroke treat by introducing a solution of Fibrinolysin with Heparin.

After that, the treatment regimen includes:

• Intramuscular injection of Heparin;
• After 3-5 days, a transition to Fenilin and Dicoumarin is recommended.

In the treatment of young and middle-aged patients, Pentoxifylline is used to help improve blood density.

Elderly patients for treatment are prescribed:

• Parmidin;
• Xanthinol nicotinate;
• Anaprilin (with existing tachycardia);
• Cavinton, Cinnarizine (allows to improve vascular tone).

Medicine has found that in ischemic stroke, the combined use of Curantyl and Aspirin will help reduce the risk of re-development of the pathology.

The patient may have arousal syndrome curable by prescribing barbiturates. Metabolic failure should be treated with the help of drugs of the class of metabolites (Piracetam, Aminalon, Cerebrolysin), which also contribute to increasing the resistance of cells to oxygen deficiency.

Surgical methods

Sometimes win stroke can be done with surgery. If a patient has been diagnosed with a hemorrhagic stroke, then surgical methods of treatment can only be used if young or middle age, and also if lateral hematomas and hemorrhages in the cerebellum have been diagnosed.

The indications for the operation are:

• The impossibility of removing cerebral edema by other means;
• The occurrence of signs of compression by a hematoma;
• Suspicion of the possibility of repeated hemorrhage in the brainstem or hemispheres.

The best time for the operation is 1-2 days. The hematoma is opened and removed. If ruptures of the aneurysm of the brain were detected, the vessel is ligated.

Surgical treatments for ischemia are used in rare cases. Indications for surgery is the diagnosis of narrowing of the carotid, vertebral or subclavian artery, causing pathology.

Patient care

In order to recover after stroke, it is very important to ensure proper patient care.

Care measures during inpatient treatment include:

Rehabilitation

Safely Eliminate consequences stroke is possible with well-organized rehabilitation.

Help for a survivor of a brain stroke should include the following measures and actions:

• Gentle massage of the limbs from the second week of illness;
• Therapeutic exercise, contributing to the restoration of motor functions with a gradual increase in intensity.
• Kinesiotherapy, which develops small hand movements, helping the patient in self-care in new conditions;
• Water procedures aimed at muscle stretching, oxygen baths, hydromassage.

With properly taken therapeutic measures for stroke, as well as well-organized rehabilitation, up to 70% of people who have had a brain stroke return to independent life. The best period for rehabilitation measures and assistance is the first three years, during which it is necessary to stock up on patience and faith in success.

Emergency care for strokes

Strokes are acute circulatory disorders in the brain (cerebral) and spinal (spinal) cord. Main clinical forms: I - transient disorders (a - transient ischemic attacks, b - hypertensive cerebral crises); II - hemorrhagic strokes (non-traumatic hemorrhage in the brain or spinal cord); III - ischemic strokes (brain infarctions) with thrombosis, embolism, stenosis or compression of blood vessels, as well as with a decrease in general hemodynamics (non-thrombotic softening).

With the embolic nature of cerebral stroke and with vein thrombosis, hemorrhagic cerebral infarction often develops; IV - combined strokes, when at the same time there are areas of softening and foci of hemorrhage.
Transient cerebrovascular accident (TIMC) is the most common variant of cerebral stroke or hypertension, atherosclerosis of cerebral vessels and the impact on these vessels of pathologically altered cervical vertebrae (spondylogenic circulatory disorders in the vertebrobasilar basin). This option includes only such observations in which cerebral and focal neurological symptoms disappear after 24 hours.
Symptoms. They are characterized by general cerebral and focal disorders. Of the cerebral symptoms, headache, dizziness of a non-systemic nature, nausea, vomiting, noise in the head, disturbances of consciousness, psychomotor agitation, and epileptiform seizures are possible. Cerebral symptoms are especially characteristic of hypertensive cerebral crises. Hypotensive crises are characterized by less pronounced cerebral symptoms and are observed against the background of low blood pressure and weakening of the pulse.
Focal symptoms most often manifest as paresthesia, numbness, tingling in local areas of the skin of the face or extremities. Motor disorders are usually limited to the hand or only fingers and paresis of the lower mimic muscles, speech disorders, dysarthria are observed, deep reflexes on the limbs increase, pathological signs appear. With stenosis or blockage of the carotid artery, the transient crossed oculopyramidal syndrome is pathognomonic: decreased vision or complete blindness in one eye and weakness in the arm and leg opposite the eye. In this case, the pulsation of the carotid arteries may change (weakening or disappearance of the pulsation on one side), during auscultation, a systolic blowing noise is heard. In case of circulatory disorders in the vertebrobasilar basin, darkening before the eyes, dizziness, coordination disorders, nystagmus, diplopia, impaired sensitivity on the face and tongue are characteristic. Transient disturbances in the large radiculomedullary arteries are manifested by myelogenic intermittent claudication (when walking or physical exertion, weakness of the lower extremities, paresthesias in them, transient disorders of the function of the pelvic organs appear, which disappear on their own after a short rest).
Diagnostics. When examining a patient, it is immediately impossible to determine whether a real cerebrovascular accident will be transient or persistent. This can be concluded only in a day.
Urgent Care. The patient must be provided with complete physical and psycho-emotional rest. The difference in the pathogenetic mechanisms of PNMK also determines various therapeutic measures. In atherosclerotic cerebrovascular insufficiency, cardiotonic ones are used (1 ml of a 0.06% solution of cortico or 0.025% solution of strophanthin is administered with glucose intravenously, 10% solution of sulfocamphocaine, 2 ml subcutaneously, intramuscularly or intravenously slowly, 1 ml cordiamine subcutaneously), vasopressor (with a sharp drop in blood pressure, 1 ml of a 1% solution of mezaton is administered subcutaneously or intramuscularly, 1 ml of a 10% solution of sodium caffeine benzoate subcutaneously) to improve cerebral blood flow (10 ml of a 2.4% solution of eufillin intravenously slowly with 10 ml saline, 4 ml of 2% papaverine solution intravenously, 5 ml of 2% trental solution in a dropper with saline or 5% glucose) preparations. Sedatives are prescribed (bromocamphor 0.25 g 2 times a day, motherwort tincture 30 drops 2 times a day) and various symptomatic remedies aimed at relieving headaches, dizziness, nausea, vomiting, hiccups, etc.
Hospitalization: to a neurological or specialized neurosurgical hospital (angioneurosurgical department).

hemorrhagic stroke.

Hemorrhage develops by two mechanisms: by the type of diapedesis and due to rupture of the vessel. Diapedetic hemorrhage occurs with hypertensive crisis, vasculitis, leukemia, hemophilia, acute coagulopathic syndrome, uremia. Hemorrhage due to rupture of the vessel occurs with arterial hypertension and local defects of the vascular wall (atherosclerotic plaque, aneurysm, etc.). Intracerebral hematoma is most often localized in the region of the basal ganglia and the internal capsule. Less commonly, a primary hematoma forms in the cerebellum and brainstem.
Symptoms. For hemorrhagic stroke of any localization, cerebral symptoms are characteristic: severe headache, nausea and vomiting, bradycardia, and rapid depression of consciousness. Focal symptoms depend on the location of the hemorrhage. More often, hemorrhagic stroke develops in middle-aged and elderly people, it occurs suddenly, at any time of the day. The patient falls, loses consciousness, vomiting appears. On examination, the face is purple, breathing is snoring (stertorous), urinary incontinence. Blood pressure is often elevated. Given the predominance of the lesion in the internal capsule of the brain, hemiplegia, hemihypesthesia can also be detected in the unconscious state of the patient. In the case of a breakthrough of blood into the subarachnoid space, meningeal symptoms join. With a breakthrough of blood into the ventricles of the brain, hormetonic convulsions develop, disorders of consciousness deepen to atonic coma, pupils dilate, body temperature rises, respiratory disorders, tachycardia increase, and death can occur in a few hours. Subarachnoid hemorrhage usually develops suddenly (aneurysm rupture), with physical exertion: a severe headache occurs, sometimes radiating along the spine, followed by nausea, vomiting, psychomotor agitation, sweating, eye symptoms, consciousness is depressed.
Diagnostics. Based on characteristic clinical symptoms and CSF study data.
Urgent Care. With a hemorrhagic stroke, the following are necessary: ​​strict bed rest, stopping bleeding, lowering blood pressure to normal, lowering intracranial pressure, combating edema and swelling of the brain, eliminating acute respiratory disorders, combating cardiovascular disorders and psychomotor agitation.
Transportation of the patient to a neurological hospital is carried out as soon as possible after the onset of a cerebral stroke with all precautions: careful placement of the patient on a stretcher and bed, maintaining a horizontal position when carrying, preventing shaking, etc. Before transportation, the patient is injected with hemostatic agents (Vikasol , dicynone, calcium gluconate), a venous tourniquet is applied to the thighs to reduce the volume of circulating blood. In case of threatening respiratory failure, transportation from the IVP, oxygen inhalation are advisable. In the early stages, the introduction of epsilon-aminocaproic acid (100 ml of a 5% solution intravenously drip) with 2000 IU of heparin is indicated. To reduce intracranial pressure, active dehydration therapy is carried out: Lasix 4-6 ml of a 1% solution (40-60 mg) IM, mannitol or mannitol (200-400 ml of a 15% solution IV drip). justified as early as possible the use of "metabolic protection" of the brain tissue and antioxidants (sodium oxybutyrate 10 ml of a 20% solution intravenously slowly - 1-2 ml per minute; piracetam 5 ml of a 20% solution IV; tocopherol acetate 1 ml 10-30 % solution intramuscularly, ascorbic acid 2 ml of a 5% solution in / in or / m. Inhibitors of fibrinolysis and proteolytic enzymes are also administered in the early stages: trasilol (kontrykal) 10,000-20,000 IU in / in drip.
It should be remembered that the development of spontaneous subarachnoid hemorrhage in young people is more often due to rupture of arterial aneurysms.
Hospitalization: urgent to the neurosurgical hospital.

Ischemic strokes.

Three groups of main etiological factors leading to ischemic stroke can be distinguished: changes in the walls of blood vessels (atherosclerosis, vasculitis), embolic lesions and hematological changes (erythrocytosis, thrombotic thrombocytopenia, hypercoagulability, etc.).
Symptoms. Patients gradually develop headache, dizziness, numbness and weakness in the limbs. The disease usually develops against the background of coronary heart disease and other signs of atherosclerosis, diabetes mellitus. At a young age, ischemic stroke is often the result of vasculitis or blood disease. Focal symptoms come to the fore of the clinical picture of the disease; cerebral symptoms develop somewhat later and are less pronounced than in hemorrhagic stroke. The face of such patients is usually pale, blood pressure is normal or elevated. With embolism of the cerebral vessels, the disease resembles a hemorrhagic stroke in the clinical picture, short-term clonic convulsions are characteristic before the development of paralysis of the limb, depression of consciousness (apoplexy) is rapidly increasing.
Urgent Care. Basic principles: containment of thrombus formation and lysis of fresh thrombi, limitation of areas of ischemia and perifocal cerebral edema, improvement of the function of the cardiovascular system, elimination of acute respiratory disorders up to 20,000 units of heparin with normal blood pressure). Together with anticoagulants, antiplatelet agents, vasodilators (5 ml of a 2% solution of pentoxifylline, intravenous trental) should be administered, hemodilution with rheopolyglucin (400 ml intravenously at a rate of 20-40 drops / min) should be administered. With a crisis rise in blood pressure, it should be reduced to a "working" level due to impaired autoregulation of cerebral circulation during this period and the dependence of cerebral blood flow on the level of blood pressure. Microcirculation is improved using dipyridamole (curantyl, persanthin - 2 ml of a 05% solution in / in or in / m), trental (0.1 g - 5 ml of a 2% solution in / in drip in 250 ml of saline or 5% solution glucose), cavinton (2-4 ml of 05% solution in 300 ml of physiological saline intravenously).
In ischemic stroke with severe cerebral edema, cerebral embolism and hemorrhagic infarction, more active use of osmodiuretics is required. With psychomotor agitation, seduxen (2-4 ml of a 05% solution in / m), haloperidol (0.1-1.0 ml of a 05% solution in / m) or sodium hydroxybutyrate (5 ml of a 20% solution in / m or / V).
Violations of the rhythm and force of contractions of the heart can be both a background against which a stroke has developed (often as an embolism), and a consequence of impaired central regulation of the heart. In the first case, urgent measures are carried out according to the same principles as for cardiac arrhythmias without cerebrovascular accident. In this case, it is desirable to avoid large doses of beta-blockers, especially anaprilin, and severe arterial hypotension. With myocardial ischemia, the full amount of appropriate assistance is provided, which, as a rule, is also useful for cerebral ischemia. If possible, agents that cause a sharp dilatation of the cerebral vessels, in particular nitroglycerin, should be avoided. Against the background of high blood pressure, this can lead to increased cerebral edema and the emergence of a persistent focus of ischemia.
Hospitalization. For all cerebral strokes, hospitalization of patients in the intensive care unit or neurological department (specialized neurovascular department) is indicated. The exception is cases with severe violations of vital functions and in a state of agony, when the transportation itself is dangerous. Respiratory resuscitation is effective enough only for small-focal lesions of the brain stem.

Emergency care for stroke: characteristic symptoms of brain damage and rules for first aid

A stroke is an acute violation of blood circulation in the vessels of the brain, resulting from blockage of the vessels of the brain by a thrombus or plaque (ischemic, about 80% of the total number of strokes) or due to hemorrhage (hemorrhagic).

Emergency care for stroke plays an important role in saving the life and capacity of the patient.

Everyone should know the signs of a stroke and be able to provide first aid. A delay of 10-15 minutes can cost a person a life.

Symptoms and Diagnosis

Cerebral (non-specific) are those disorders that indirectly speak of a stroke:

• sudden short-term loss of consciousness;
• a state of stupor - the reaction to external stimuli is very inhibited, the person is in a confused mind;
• lack of normal orientation in space and time;
• severe headache leading to vomiting;
• a feeling of intense paroxysmal heat, chills and excessive sweating (usually characterized as “hot, cold”);
• palpitations are noted;
• bouts of intense thirst, dry mouth.

Stroke is the second leading cause of death in Russia. This is a serious pathology, in 87% of cases leading to disability or death. Only 13% of stroke patients are successfully treated and fully recover. But half of the people who survived the first stroke develop a second cerebrovascular accident over the next 5 years.

Symptoms of focal (specific) brain damage:

• movement disorders (weakness in the limbs, inability to perform simple actions);
• paresthesia - sensations of tingling, goosebumps, numbness;
• “crooked smile”, when, when a person tries to smile, the muscles of only one half of the face contract;
• speech pathologies and disorders - a person is not able to clearly communicate coherently;
• nystagmus - involuntary frequent oscillatory movements of the eyeball;
• various visual impairments, including double vision - diplopia.

For reliable diagnosis, MRI (magnetic resonance imaging) or CT (computed tomography) studies are performed. In the first 12-24 hours, the lesion area may not be noted on the CT results, so MRI diagnostics is considered more preferable.

Not all hospitals can afford prompt MRI, CT and instant interpretation of the results.

Therefore, in most cases, the diagnosis is limited to a general examination of the patient, echoencephalography (EEG) and lumbar puncture.

A lumbar puncture is the removal of a small amount of cerebrospinal fluid for examination through a puncture in the lumbar region.

A differentiated diagnosis is carried out to determine what type of brain damage has occurred in the patient:

Emergency care for a stroke

Emergency care for stroke

Cerebral stroke is an acute violation of cerebral circulation. In most cases, the cause of a stroke is hypertension and atherosclerosis, less often - valvular heart disease, myocardial infarction, congenital anomalies of cerebral vessels and arteritis.

At the prehospital stage it is necessary:

Free the airways from vomit; introduce an air duct, if necessary - a ventilator;

Give the head an elevated position to reduce intracranial pressure, put ice on the head. With urinary retention, it is necessary to drain the urine with a catheter; cleanse the intestines with a cleansing enema;

First aid for stroke

Stroke is one of the most dangerous diseases of the cardiovascular system. According to statistics in Russia, every minute someone has a violation of cerebral circulation - stroke. including microstroke. Stroke occurs even more often than myocardial infarction.

Mortality from stroke in the first month is 20-25%, in the first year more than 1/3 of patients die from complications caused by impaired cerebral circulation, and 30-40% become disabled. Such depressing statistics are caused not only by the severity of the disease, but also by untimely (unqualified) assistance. Patients who received qualified medical care in the first three hours (maximum 6) have a chance to fully (as far as possible) restore all the functions lost as a result of a stroke. This period (3 hours) even got its name "therapeutic window", then irreversible pathological changes begin.

All patients with such a diagnosis should be hospitalized - especially if cerebrovascular accidents occurred at work, on the street, in transport. The doctor, having made a Computed or Magnetic Resonance Imaging, must determine what caused the violation of cerebral circulation: blockage of blood vessels or hemorrhage. If this is a hemorrhage (Hemorrhagic stroke), then in which place it occurred, it is also necessary to restore the work of the vessels as soon as possible and remove the blood. If there is a blockage of blood vessels, then the doctor will inject a drug that dissolves the blood clot.

The first symptoms of a stroke

The disease proceeds individually for everyone. The symptoms of a stroke depend on what type of stroke the person has and what area of ​​the brain is damaged. The most common symptoms:

• headache;
• dizziness, sometimes accompanied by nausea. vomiting;
• possible loss of consciousness;
• weakness, numbness in half of the face, paralysis in the arm, in the leg;
• violation of speech, memory, ability to reason logically;
• increased pain in half of the body.

If at least two of the above symptoms appear in you, a family member, a colleague, it is a reason to immediately call an ambulance. Describe the symptoms to the dispatcher so that the ambulance team arrives well prepared, with a planned action plan. Do not self-medicate, remember that you have three hours to return to normal life.

Actions before the arrival of the doctor

The patient must be laid down, putting a pillow under his head, shoulders and shoulder blades, so that the head makes an angle of approximately 30 ° to the bed, floor, bench. Provide access to fresh air, for this, remove tight clothing, unbutton your shirt collar, open a window, if there is an air conditioner, turn it on. Remove removable dentures.

If there is vomiting, turn your head to the side, wrap your hand with a clean handkerchief or gauze and clean your mouth of vomit. Throwing them into the respiratory tract threatens with a severe form of pneumonia, which will then be difficult to fight.

Be sure to measure your blood pressure. It used to be considered: if it is increased, it should be reduced to 120/80 mm Hg. Art. A sharp decrease in pressure is no less dangerous than its high values! What to do? Usually a person knows his "working" numbers. For example, he feels good at 150/80 mmHg. Art. It is necessary to focus on numbers that exceed the "working" ones by 5-10 mm Hg. Art. and give an antihypertensive drug (preferably the one to which the victim is accustomed, uses in everyday life). A sharp drop in blood pressure can increase the focus of ischemia, which in turn will cause new disorders, in particular, paresis can turn into paralysis.

Something to relieve pressure? Are you afraid of overdosing your medicine? Do not be alarmed and consider if blood pressure has increased to 180 mm Hg. Art. in a person who did not suffer from arterial hypertension, and up to 200 mm Hg. Art. - in hypertensive patients, this is not very scary. Better not to correct it at all. You can resort to non-drug methods: ask the patient to inhale deeply and hold the breath for as long as possible. It is very important to measure the pulse. After all, some types of stroke are caused just by atrial fibrillation. If the pulse "breaks", give the patient the drug that he usually takes in such cases. Do not self-medicate, do not inject any drugs that affect the vessels and structures of the brain! Glycine (aminoacetic acid) may be recommended. In a critical situation, it is recommended to give it one gram (10 tablets under the tongue) per dose or 5 tablets 3 times with an interval of 30 minutes. It will not bring any harm and will ease the course of the disease.

If the stroke attack happened on the street, your steps to help are similar. Ask someone to call an ambulance. Lay down the victim. Make sure that he does not choke on vomit, provide air access by unbuttoning the buttons, belt, belt. The decision is always unequivocal - it is necessary to take to the hospital. If it is not possible to call an ambulance, take the patient by any means of transport, remember the "therapeutic window".

If you use personal transport, then unfold the car seat, lay the patient down (at an angle of 30 °), be sure to remove dentures, turn his head to one side and make sure that he does not choke on his own saliva or vomit. Do not forget the sphygmomanometer, measure your blood pressure and pulse. Even if you have nothing to correct them, information about the changes will help doctors make a correct diagnosis and quickly begin adequate treatment.

First aid for stroke

A stroke is a violation of cerebral circulation. The arteries supplying blood to the brain may become clogged, and then an ischemic stroke occurs, or an artery may rupture and this is a hemorrhagic stroke. Thus, as a result of this vascular catastrophe, part of the brain remains without normal blood supply, experiencing oxygen starvation. As a result of hypoxia - a lack of oxygen in the tissues, nerve cells die. This leads to a variety of neurological symptoms, it can be a complete or partial loss of speech, memory lapses, paralysis of body parts (hemiparesis).

Among all strokes, the ischemic variant occurs in 80% of cases. Blockage of the arteries supplying the brain with oxygenated blood is most often caused by cholesterol deposits. Ischemic strokes most often occur against the background of low blood pressure and occur mainly in the morning. If the artery is not very large in diameter, then the clinic of such a stroke develops gradually, begins with weakness, dizziness, numbness of the face, arm and (or) leg on one side, visual and speech disorders may occur, the corners of the mouth become asymmetrical, headache may occur , loss of balance. When blocking a large diameter artery, it is extremely difficult to make a differential diagnosis between ischemic and hemorrhagic stroke at the prehospital stage.

A cerebral hemorrhage (hemorrhagic stroke) occurs when a blood vessel ruptures and the surrounding tissues fill with blood. This disrupts the normal blood flow to the brain, the outflow of blood compresses the brain tissue, leading to further damage. Most often, hemorrhagic strokes occur against the background of high blood pressure.

With a decrease in the lumen of the vessels supplying the brain with blood and, accordingly, a deterioration in its nutrition, it is necessary to prescribe drugs that reduce blood clotting (blood thinning) - this can be aspirin, which is used for quite a long time at ¼ tablets per day, or newer drugs - warfarin, at a dose of prescribed by the treating doctor. The drug clopidogrel or zylt is now being used, which is also recommended by neurologists as a disaggregant, including at the prehospital stage.

What to do

Emergency care for severe stroke at the prehospital stage does not require an accurate definition of its nature (hemorrhage or ischemia). The basic principles of such emergency assistance are to create conditions for the normalization of the vital functions of the body - this is breathing and blood circulation, the fight against cerebral edema. Respiratory disorders during loss of consciousness may be due to impaired airway patency, which means that it is necessary to exclude the retraction of the tongue, the ingress of vomit into the trachea and bronchial tree, and for this the patient's head must be turned to one side. According to modern recommendations of neurologists, blood pressure correction is carried out only if it significantly exceeds normal values, since low blood pressure in stroke patients usually leads to a worsening of its condition and further prognosis.

The patient needs to provide oxygen supply, drugs with antihypoxic action are prescribed. To date, preference is given to the drug - mexidol, which must be administered intravenously, at a dose of 5 milliliters, diluted in saline. Of the drugs that improve cerebral circulation, neurologists today recommend the use of a magnesium sulfate solution at the prehospital stage. From the use of aminophylline in strokes, they have now moved away and are no longer recommended. With the threat of cerebral edema, oxygen therapy continues, diuretics (lasix) are prescribed. In case of seizures - anticonvulsant therapy (Relanium). The patient should be hospitalized in the vascular center, in the primary vascular department, or in the nearest medical institution with an intensive care unit, since quite often such patients require intensive care, including resuscitation.

Prevention measures are to protect blood vessels, and this is, first of all, quitting smoking, since nothing destroys the vascular wall like the components of tobacco smoke (and there are more than three hundred components!), control and treatment of arterial hypertension, diet, regular physical activity. It is worth recalling that 80% of our health, according to WHO, depends on our lifestyle.

First aid for stroke

Ivan Drozdov 04.02.2018 0 Comments

Stroke is a life-threatening disease, in most cases leading to disability and even death. The likelihood of developing dangerous consequences depends on the time interval that has elapsed between the peak of the attack and the provision of medical care in the hospital. A stroke victim, people around him and doctors have no more than 4 hours to restore blood flow to the brain. Therefore, prompt first aid for a stroke is extremely important, during this period it is necessary to recognize an attack by characteristic symptoms, reduce the impact of the attack by providing primary care before the arrival of doctors, take the victim to the hospital and prescribe treatment.

The first signs of a stroke

It is possible to recognize a stroke and the nature of its development mechanism by a complex of general neurological and specific symptoms in order to provide first aid in a timely manner. Common primary signs that occur spontaneously without any precursors include:

• numbness of the limbs - in most cases on one side of the body;
• darkening and double vision;
• impaired coordination and orientation;
• brief bouts of amnesia;
• speech disorder.

Manifestations ischemic stroke have their own characteristics:

• paralysis of the body or limbs develops on one side, almost always the opposite side of the brain cell lesion;
• the gait becomes unsteady and shaky, often the victim cannot stand on his own;
• speech becomes difficult, articulation and perception of what is said is reduced;
• dizziness occurs, accompanied by bouts of vomiting.

I will attack hemorrhagic stroke quite often preceded by a sharp increase in blood pressure - a hypertensive crisis. As a result, an artery ruptures and a hemorrhage occurs in the brain tissue. At the time of an attack, a person has:

• sharp and unbearable pain, it feels like tearing the head;
• rapid heart rate;
• distortion of the face against the background of increased muscle tone;
• paralysis;
• high photosensitivity, dots and blurry circles before the eyes.

Signs that allow you to finally diagnose a stroke before the arrival of doctors include:

• asymmetrical smile and the impossibility of raising one of the corners of the lips;
• impaired articulation and inhibited speech;
• asymmetrical movement of the limbs when trying to simultaneously lift them up.

If, with a sudden deterioration in well-being, a person has at least a few of the described signs, an intensive care ambulance should be immediately called and taken to a hospital.

First aid for stroke at home

At the first signs of a stroke, despite the presence of consciousness in the victim and his assurance that everything is in order, the people nearby should promptly call an ambulance, while describing in detail to the dispatcher the symptoms of brain failure that have appeared. Before the arrival of doctors, the patient must be provided with primary care to alleviate the condition:

1. In the case of special instructions from the dispatcher, follow them implicitly.
2. Gently place the victim in a position in which the head is raised to 30 ° and slightly turned to one side. This is necessary so that in the event of sudden vomiting, food debris does not enter the respiratory organs, and in case of loss of consciousness, the tongue does not sunk.
3. Open a window or vent so that fresh air enters the room where the victim is located.
4. Reassure the patient if he is overexcited or begins to get nervous due to limited mobility. It should be explained in a calm tone that medical assistance will soon be provided to him to alleviate his condition.
5. Measure the pressure and, if possible, the level of sugar, record the results of the measurements in order to subsequently inform the doctors.
6. Remove or unfasten clothing items that squeeze the throat, chest, belt.
7. In the absence of consciousness, breathing and heartbeat, immediately perform chest compressions and artificial respiration.

There are also methods of primary care for stroke, which are not always recognized by traditional medicine, but are quite effective in practice. The main one is the method of acupuncture. An unconscious victim is pierced with an alcohol-treated needle on the fingertips until 2 or -3 drops of blood appear.

Also, with a pronounced asymmetry of the face, the patient's earlobes are intensively rubbed, after which they are pierced with a needle until blood appears. This technique quite often brings the patient to consciousness and allows you to relieve tension in the structures of the brain.

to the actions that forbidden to perform if a stroke is suspected, include:

• strong shaking of the victim, sudden movements, screams and hysteria of others;
• feeding and drinking plenty of water;
• bringing to life with ammonia and other acid-containing agents;
• attempts to eliminate the symptoms of brain failure on their own with pharmaceutical means;

First aid for stroke

Before the arrival of the ambulance team, it is not recommended for the victim to independently give any medications, except in cases where the ambulance dispatcher can make a single appointment based on the symptoms described.

Medical assistance is provided by ambulance paramedics. Directly in the resuscitation vehicle, doctors perform operational actions aimed at maintaining the vital signs of the body. These include:

• indirect heart massage;
• artificial respiration;
• tracheal intubation;
• the introduction of blood-thinning drugs for symptoms of ischemic stroke;
• the introduction of anticonvulsants in severe convulsive syndrome;
• lowering blood pressure with medications, if its indicators are critically increased;
• the introduction of osmodiuretics, if the victim shows signs of cerebral edema;
• the introduction of thrombogenic agents, if hemorrhagic stroke is diagnosed;
• the introduction of drugs that improve blood flow through the vessels and arteries.

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After the patient is delivered to the hospital, it is extremely important to promptly confirm the preliminary diagnosis with instrumental methods and prescribe adequate treatment aimed at restoring blood flow and damaged nerve tissues.

The help provided in the first seconds after the attack, and medical care during the first three hours, is tantamount to saving a life.

A stroke is a sudden disruption or interruption of the blood supply to the brain. If there is a blockage of the blood vessel of the brain by a thrombus, an ischemic stroke develops. Rupture of a blood vessel leads to a hemorrhagic stroke. Both types of circulatory disorders in a stroke can lead to brain cell death or death. Therefore, it is so important to be able to provide people with first aid for strokes before the ambulance arrives.

Stroke ranks fifth in the list of all types of death from the disease. But the worst of all are the consequences that this pathology entails: paralysis, loss of vision, impaired speech, changes in thinking and consciousness.

The first signs of a stroke may occur among women aged from 18 to 40 years old. Ignoring these "bells" increases the risk of having a stroke. In men, the disease often occurs by the age of 40, they suffer a stroke more easily than women, and recover faster.

The development of a stroke can be prevented if its precursors are recognized in time, consult a doctor and do not forget about prevention.

Harbingers of a stroke:

• sudden weakness, rapid fatigue;
• severe headache;
• change, double vision (even short-term);
• feeling of numbness of the hand;
• severe dizziness;
• sudden, momentary disturbances in spatial orientation;
• speech difficulties, the simplest, familiar words are forgotten;
• impaired ability to concentrate thoughts.

These symptoms can be signs not only of a stroke, but also of other pathologies. But in any case, you should consult a doctor, because often such symptoms are associated with insufficient blood supply, which can lead to a stroke, cause irreversible damage to the nervous tissue of the brain.

Ischemic stroke

Ischemic stroke clinic:

• occurs in the morning or during a night's rest;
• the patient's consciousness is not impaired;
• there is weakness of the limbs on one side of the body;
• there are signs of speech impairment, facial distortion.

Hemorrhagic stroke

When a brain vessel ruptures, a person may temporarily lose their hearing and may lose consciousness.

Symptoms:

• severe headache, hearing loss;
• occur with high psycho-emotional or physical stress;
• the patient is unconscious;
• there is a strong tension of the occipital muscles;
• blood pressure is very high;
• convulsions, paralysis of the limbs develop.

Calling an ambulance is required. A stroke cannot be cured at home. It is necessary to take the person to a medical facility as soon as possible within the first 3 hours in order to reduce brain damage after a circulatory failure.

At-risk groups

Stress and prolonged emotional overstrain can lead to a stroke at a fairly young age.

People of working age most often fall into the risk group for the likelihood of developing a stroke. The main causes leading to the development of a stroke:

• arterial hypertension;
• violation of cerebral circulation;
• cardiovascular pathologies;
• stress and prolonged emotional overstrain;
• atherosclerosis, high blood cholesterol;
• diabetes mellitus, obesity, genetic predisposition;
• smoking, use of contraceptive pills by women;
• elderly age.

How to recognize a stroke

Face - hand - speech - test. These are not just words, but criteria that need to be evaluated if a stroke is suspected. In the Russian-language literature, the test was called "UPZ", which means "smile, raise both hands, speak":

signs	What to pay attention to.
	Ask the patient to smile, show teeth. Alarm signal: The appearance of facial asymmetry, weakness of facial muscles on the affected side.
	Ask to raise both hands palms up, parallel to the floor, hold them for 5 seconds, then lower them. If the person is lying down, the arms can be raised 45 degrees. Alarm signal: Lowering one of the arms due to the weakness of the muscles that has appeared.
	Ask to say any simple phrase, for example, FIRST NAME Alarm signal: Unintelligible speech, misunderstanding of words in simple commands or phrases signals speech disorders.

Important: If there are no symptoms, but the patient's condition is alarming, you need to call an ambulance without delay or take the person to the doctor.

Emergency first aid for stroke

For the provision of the first, prehospital stage of first aid, only 5-10 seconds so there is no need to panic. It is necessary to immediately call an ambulance - the faster qualified assistance is provided to the victim, the greater the chance of saving life and restoring health.

General instruction

How to provide first aid for a suspected stroke

Action	Description
	Call an ambulance
	Check the presence of consciousness: gently shake the person, ask a question.
	Determine if the victim is breathing: bend your ear low to your face, listen for sounds, catch if the chest is moving.
	Check on the carotid artery for a pulse. If possible, measure the pressure - these data will be needed by ambulance doctors.
	If there is no spontaneous breathing, start. If there is a pulse, take 12 breaths per minute.
	Position the patient carefully. To prevent cerebral edema, raise your head a little by 20-30 cm, placing a pillow, rolled towel or other object under it.
	Tilt your head back a little, grab your lower jaw with your fingers and push it forward a little. If necessary, clean the mouth of dentures.
	During vomiting, carefully turn the patient on the right side.
	Unfasten your clothes so that nothing constrains your neck and chest. Provide fresh air.
	With convulsions, you need to hold your head so that the person does not hit, does not choke on the foam that comes out of the mouth.
	It is impossible to move, shift to another place a person with a stroke - a rupture of blood vessels may occur.
	From the moment the first signs appear, assistance should be provided within 3 hours.

Help with hemorrhagic stroke

In hemorrhagic stroke, two rules are added to the standard prehospital care:

1. To ensure the outflow of blood, be sure to put a pillow, a roller from a jacket, a bag under the patient's head.
2. Apply an ice pack (bottle of cold water) to the head (presumably on the side where the hemorrhagic stroke occurred).

In ischemic stroke, first aid is standard, according to the algorithm.

Help on the street

If you saw a person on the street who had a stroke:

Assistance in enclosed spaces

When providing assistance in enclosed spaces (in offices, shops, at home), in addition to the standard algorithm for providing assistance to the victim:

• you need to create an influx of fresh air - open the door, window, balcony;
• measure blood pressure (you can ask for a device at your nearest pharmacy).

Caution: Never give any medication to a sick person unless you are a doctor. Do not bring the person to life with ammonia - it can cause respiratory arrest.

If you are confused and do not know what specific assistance you need to provide to a person:

• ask someone again call back by phone 103 or 112;
• describe the patient's condition and get recommendations for your next steps.

Watch the video at the link in this article: the author briefly talks about first aid for a stroke.

Chinese technique: needle for stroke

Chinese doctors, in order to help a person with a stroke, offer to bleed all 10 fingers and earlobes with a sterile needle. The punctures need to be made small so that only blood flows.

But not all doctors agree with the effectiveness of this method:

• earlobe piercing can only be done by an acupuncturist;
• bloodletting can only help as an emergency treatment for high blood pressure.

Chinese medicine suggests using a sterile needle to puncture all 10 fingertips on the hands and both earlobes, and squeeze out a drop of blood.

After the ambulance delivered the patient to the hospital, the treatment of stroke symptoms takes place in several stages:

• intensive care in the intensive care unit to reduce, reduce brain damage, risk of death,
• conservative therapy in the neurological or cardiology department;
• rehabilitation treatment in a rehabilitation center;
• physical therapy, speech exercises, massage, water procedures at home.

According to statistics, competent first aid in the first three hours after a stroke saves the lives of at least 50-60% of patients, even with severe forms of stroke. The disease is very rejuvenated, affecting both the elderly and young, twenty-five-year-old people. Therefore, you need to be prepared to, if necessary, be able to recognize a stroke, provide quick and competent assistance to the victim.

Emergency care for hemorrhagic stroke should be carried out in a neurological or intensive care unit, according to the principles formulated by B. S. Vilensky (1986):

1. Normalization of vital functions (see the topic GENERAL ISSUES OF REANIMATOLOGY).

2. The patient should be put to bed with raised head end.

3. With hemorrhagic stroke means having the properties of hemostatics and angioprotectors are shown. The drug of choice for this purpose is dicynone (synonyms: etamsylate, cyclonamide). The hemostatic effect of dicynone with intravenous administration begins after 5-15 minutes. the maximum effect occurs after 1-2 hours, the action lasts 4-6 hours or more. Enter in / in 2-4 ml of 12.5% ​​solution, then every 4-6 hours, 2 ml. It can be administered intravenously by drip, adding to conventional infusion solutions (MD Mashkovsky, 1997).

4. For normalization of blood pressure at the emergency stage, you can use intravenous injections of dibazol (2-4 ml of 1% solution), clonidine (1 ml of 0.01% solution), droperidol (2-4 ml of 0.25% solution) . In the absence of effect, ganglioblockers are indicated - pentamine (1 ml of 5% solution) or benzohexonium (1 ml of 2.5% solution), but the introduction of these drugs should be done with caution and constant monitoring of blood pressure.

5. Due to the sharp increase fibrinolysis cerebrospinal fluid shows epsilon-aminocaproic acid from 20 to 30 g / 24 hours during the first 3-6 weeks (F. E. Gorbacheva, A. A. Skoromei, N. N. Yakhno, 1995).

6. Relief of cerebral edema and intracranial hypertension - see topic BRAIN EDEMATION.

7. Relief of hyperthermic syndrome(if any); convulsive syndrome (if any).

8. In the absence of consciousness, preventive antibiotics are prescribed to prevent the development of pneumonia.

9. Care aimed at preventing trophic complications (pressure sores).

10. Control of bowel function.

11. Symptomatic therapy.

Note. The listed activities are adapted to the specific situation.

First aid for stroke

First aid for a stroke begins in the first few minutes after the disease. This will help to avoid the development of irreversible processes in the brain and prevent death. It is known that the next three hours after a stroke are a crucial period of time and are called the therapeutic window. If first aid for a stroke was provided correctly and within these 3 hours, then there is hope for a favorable outcome of the disease and a normal subsequent restoration of body functions.

Types of strokes:

1. Ischemic stroke is a cerebral infarction. It accounts for more than 75% of all cases.
2. Hemorrhagic stroke - bleeding in the brain.

Stroke - symptoms and first aid

Signs of a hemorrhagic stroke:

1. Sharp severe headache.
2. Hearing loss.
3. Vomit.
4. Paralysis of the limbs.
5. Distorted expression.
6. Increased salivation.

Symptoms of ischemic stroke:

1. Gradual numbness of the limbs.
2. Weakness in an arm or leg on one side of the body.
3. Speech disorders.
4. Facial numbness.
5. Headache.
6. Dizziness.
7. Loss of coordination.
8. Visual impairment.
9. Seizures.

First of all, emergency medical care should be called for a stroke or when its obvious symptoms appear. It should be noted that when calling, it is necessary to describe in detail the signs of the disease and the patient's condition.

Emergency care for a stroke

After calling the neurological team, it is necessary to provide first aid to the victim of a stroke.

Hemorrhagic stroke - first aid:

• lay the patient on the bed or on the floor so that the shoulders and head are slightly raised (about 30% of the surface). It is important not to move the victim too much and not allow him to go home if the stroke occurred on the street;
• remove or unfasten all squeezing items of clothing (collar, tie, belt);
• if there are prostheses in the mouth, they must be removed;
• provide access to fresh air;
• the head of the victim should be slightly tilted to one side;
• when vomiting, thoroughly clean the oral cavity with gauze or other natural tissue;
• put something cold on the head (a bottle of water or a frozen product). The compress is applied to that side of the head, which is opposite to the numb or paralyzed limbs;
• maintain blood circulation in the arms and legs (cover with a blanket, put a heating pad or mustard plaster);
• monitor salivation, clean the oral cavity from excess saliva in time;
• in case of paralysis, rub the limbs with any oil-alcohol mixture (you need to mix 2 parts of vegetable oil and 1 part of alcohol).

First aid for ischemic stroke:

Emergency care for strokes

Strokes are acute circulatory disorders in the brain (cerebral) and spinal (spinal) cord. Main clinical forms: I - transient disorders (a - transient ischemic attacks, b - hypertensive cerebral crises); II - hemorrhagic strokes (non-traumatic hemorrhage in the brain or spinal cord); III - ischemic strokes (brain infarctions) with thrombosis, embolism, stenosis or compression of blood vessels, as well as with a decrease in general hemodynamics (non-thrombotic softening).

With the embolic nature of cerebral stroke and with vein thrombosis, hemorrhagic cerebral infarction often develops; IV - combined strokes, when at the same time there are areas of softening and foci of hemorrhage.

Transient cerebrovascular accident (TIMC) is the most common variant of cerebral stroke or hypertension, atherosclerosis of cerebral vessels and the impact on these vessels of pathologically altered cervical vertebrae (spondylogenic circulatory disorders in the vertebrobasilar basin). This option includes only such observations in which cerebral and focal neurological symptoms disappear after 24 hours.

Symptoms. They are characterized by general cerebral and focal disorders. Of the cerebral symptoms, headache, dizziness of a non-systemic nature, nausea, vomiting, noise in the head, disturbances of consciousness, psychomotor agitation, and epileptiform seizures are possible. Cerebral symptoms are especially characteristic of hypertensive cerebral crises. Hypotensive crises are characterized by less pronounced cerebral symptoms and are observed against the background of low blood pressure and weakening of the pulse.

Focal symptoms most often manifest as paresthesia, numbness, tingling in local areas of the skin of the face or extremities. Motor disorders are usually limited to the hand or only fingers and paresis of the lower mimic muscles, speech disorders, dysarthria are observed, deep reflexes on the limbs increase, pathological signs appear. With stenosis or blockage of the carotid artery, the transient crossed oculopyramidal syndrome is pathognomonic: decreased vision or complete blindness in one eye and weakness in the arm and leg opposite the eye. In this case, the pulsation of the carotid arteries may change (weakening or disappearance of the pulsation on one side), during auscultation, a systolic blowing noise is heard. In case of circulatory disorders in the vertebrobasilar basin, darkening before the eyes, dizziness, coordination disorders, nystagmus, diplopia, impaired sensitivity on the face and tongue are characteristic. Transient disturbances in the large radiculomedullary arteries are manifested by myelogenic intermittent claudication (when walking or physical exertion, weakness of the lower extremities, paresthesias in them, transient disorders of the function of the pelvic organs appear, which disappear on their own after a short rest).

Diagnostics. When examining a patient, it is immediately impossible to determine whether a real cerebrovascular accident will be transient or persistent. This can be concluded only in a day.

Urgent Care. The patient must be provided with complete physical and psycho-emotional rest. The difference in the pathogenetic mechanisms of PNMK also determines various therapeutic measures. In atherosclerotic cerebrovascular insufficiency, cardiotonic ones are used (1 ml of a 0.06% solution of cortico or 0.025% solution of strophanthin is administered with glucose intravenously, 10% solution of sulfocamphocaine, 2 ml subcutaneously, intramuscularly or intravenously slowly, 1 ml cordiamine subcutaneously), vasopressor (with a sharp drop in blood pressure, 1 ml of a 1% solution of mezaton is administered subcutaneously or intramuscularly, 1 ml of a 10% solution of sodium caffeine benzoate subcutaneously) to improve cerebral blood flow (10 ml of a 2.4% solution of eufillin intravenously slowly with 10 ml saline, 4 ml of 2% papaverine solution intravenously, 5 ml of 2% trental solution in a dropper with saline or 5% glucose) preparations. Sedatives are prescribed (bromocamphor 0.25 g 2 times a day, motherwort tincture 30 drops 2 times a day) and various symptomatic remedies aimed at relieving headaches, dizziness, nausea, vomiting, hiccups, etc.

Hospitalization. to a neurological or specialized neurosurgical hospital (angioneurosurgical department).

hemorrhagic stroke.

Hemorrhage develops by two mechanisms: by the type of diapedesis and due to rupture of the vessel. Diapedetic hemorrhage occurs with hypertensive crisis, vasculitis, leukemia, hemophilia, acute coagulopathic syndrome, uremia. Hemorrhage due to rupture of the vessel occurs with arterial hypertension and local defects of the vascular wall (atherosclerotic plaque, aneurysm, etc.). Intracerebral hematoma is most often localized in the region of the basal ganglia and the internal capsule. Less commonly, a primary hematoma forms in the cerebellum and brainstem.

Symptoms. For hemorrhagic stroke of any localization, cerebral symptoms are characteristic: severe headache, nausea and vomiting, bradycardia, and rapid depression of consciousness. Focal symptoms depend on the location of the hemorrhage. More often, hemorrhagic stroke develops in middle-aged and elderly people, it occurs suddenly, at any time of the day. The patient falls, loses consciousness, vomiting appears. On examination, the face is purple, breathing is snoring (stertorous), urinary incontinence. Blood pressure is often elevated. Given the predominance of the lesion in the internal capsule of the brain, hemiplegia, hemihypesthesia can also be detected in the unconscious state of the patient. In the case of a breakthrough of blood into the subarachnoid space, meningeal symptoms join. With a breakthrough of blood into the ventricles of the brain, hormetonic convulsions develop, disorders of consciousness deepen to atonic coma, pupils dilate, body temperature rises, respiratory disorders, tachycardia increase, and death can occur in a few hours. Subarachnoid hemorrhage usually develops suddenly (aneurysm rupture), with physical exertion: a severe headache occurs, sometimes radiating along the spine, followed by nausea, vomiting, psychomotor agitation, sweating, eye symptoms, consciousness is depressed.

Diagnostics. Based on characteristic clinical symptoms and CSF study data.

Urgent Care. With a hemorrhagic stroke, the following are necessary: ​​strict bed rest, stopping bleeding, lowering blood pressure to normal, lowering intracranial pressure, combating edema and swelling of the brain, eliminating acute respiratory disorders, combating cardiovascular disorders and psychomotor agitation.

Transportation of the patient to a neurological hospital is carried out as soon as possible after the onset of a cerebral stroke with all precautions: careful placement of the patient on a stretcher and bed, maintaining a horizontal position when carrying, preventing shaking, etc. Before transportation, the patient is injected with hemostatic agents (Vikasol , dicynone, calcium gluconate), a venous tourniquet is applied to the thighs to reduce the volume of circulating blood. In case of threatening respiratory failure, transportation from the IVP, oxygen inhalation are advisable. In the early stages, the introduction of epsilon-aminocaproic acid (100 ml of a 5% solution intravenously drip) with 2000 IU of heparin is indicated. To reduce intracranial pressure, active dehydration therapy is carried out: Lasix 4-6 ml of a 1% solution (40-60 mg) IM, mannitol or mannitol (200-400 ml of a 15% solution IV drip). justified as early as possible the use of "metabolic protection" of the brain tissue and antioxidants (sodium oxybutyrate 10 ml of a 20% solution intravenously slowly - 1-2 ml per minute; piracetam 5 ml of a 20% solution IV; tocopherol acetate 1 ml 10-30 % solution intramuscularly, ascorbic acid 2 ml of a 5% solution in / in or / m. Inhibitors of fibrinolysis and proteolytic enzymes are also administered in the early stages: trasilol (kontrykal) 10,000-20,000 IU in / in drip.

It should be remembered that the development of spontaneous subarachnoid hemorrhage in young people is more often due to rupture of arterial aneurysms.

Hospitalization. urgent to the neurosurgical hospital.

Ischemic strokes.

Three groups of main etiological factors leading to ischemic stroke can be distinguished: changes in the walls of blood vessels (atherosclerosis, vasculitis), embolic lesions and hematological changes (erythrocytosis, thrombotic thrombocytopenia, hypercoagulability, etc.).

Symptoms. Patients gradually develop headache, dizziness, numbness and weakness in the limbs. The disease usually develops against the background of coronary heart disease and other signs of atherosclerosis, diabetes mellitus. At a young age, ischemic stroke is often the result of vasculitis or blood disease. Focal symptoms come to the fore of the clinical picture of the disease; cerebral symptoms develop somewhat later and are less pronounced than in hemorrhagic stroke. The face of such patients is usually pale, blood pressure is normal or elevated. With embolism of the cerebral vessels, the disease resembles a hemorrhagic stroke in the clinical picture, short-term clonic convulsions are characteristic before the development of paralysis of the limb, depression of consciousness (apoplexy) is rapidly increasing.

Urgent Care. Basic principles: containment of thrombus formation and lysis of fresh thrombi, limitation of areas of ischemia and perifocal cerebral edema, improvement of the function of the cardiovascular system, elimination of acute respiratory disorders up to 20,000 units of heparin with normal blood pressure). Together with anticoagulants, antiplatelet agents, vasodilators (5 ml of a 2% solution of pentoxifylline, intravenous trental) should be administered, hemodilution with rheopolyglucin (400 ml intravenously at a rate of 20-40 drops / min) should be administered. With a crisis rise in blood pressure, it should be reduced to a "working" level due to impaired autoregulation of cerebral circulation during this period and the dependence of cerebral blood flow on the level of blood pressure. Microcirculation is improved using dipyridamole (curantyl, persanthin - 2 ml of a 05% solution in / in or in / m), trental (0.1 g - 5 ml of a 2% solution in / in drip in 250 ml of saline or 5% solution glucose), cavinton (2-4 ml of 05% solution in 300 ml of physiological saline intravenously).

In ischemic stroke with severe cerebral edema, cerebral embolism and hemorrhagic infarction, more active use of osmodiuretics is required. With psychomotor agitation, seduxen (2-4 ml of a 05% solution in / m), haloperidol (0.1-1.0 ml of a 05% solution in / m) or sodium hydroxybutyrate (5 ml of a 20% solution in / m or / V).

Violations of the rhythm and force of contractions of the heart can be both a background against which a stroke has developed (often as an embolism), and a consequence of impaired central regulation of the heart. In the first case, urgent measures are carried out according to the same principles as for cardiac arrhythmias without cerebrovascular accident. In this case, it is desirable to avoid large doses of beta-blockers, especially anaprilin, and severe arterial hypotension. With myocardial ischemia, the full amount of appropriate assistance is provided, which, as a rule, is also useful for cerebral ischemia. If possible, agents that cause a sharp dilatation of the cerebral vessels, in particular nitroglycerin, should be avoided. Against the background of high blood pressure, this can lead to increased cerebral edema and the emergence of a persistent focus of ischemia.

Hospitalization. For all cerebral strokes, hospitalization of patients in the intensive care unit or neurological department (specialized neurovascular department) is indicated. The exception is cases with severe violations of vital functions and in a state of agony, when the transportation itself is dangerous. Respiratory resuscitation is effective enough only for small-focal lesions of the brain stem.

Contrary to popular belief, a stroke is not a disease. Yes, such a diagnosis exists and is being made, but more and more specialists cease to consider stroke as an independent disease, calling it a complication of a number of vascular diseases. In terms of frequency, this pathology ranks second among all causes of death. That is why knowledge of its symptoms and diagnostic methods (including the pre-hospital stage) can seriously affect the health status of both the whole society and the individual.

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Types of stroke

Specialists distinguish between two main types of stroke according to its main cause:

• Ischemic stroke, arising as a result of various disorders leading to a sharp deterioration in the blood supply to areas of the brain;
• Hemorrhagic stroke, which refers to the outpouring of blood from vessels of various calibers; in this case, pathological changes in the brain are caused by a developing and growing hematoma that compresses the brain structures.

There is a separate classification of ischemic stroke, which takes into account most of the diseases leading to its development. It is interesting only for specialists, but it is important for us to understand in what cases this most severe pathology can develop.

Causes of a stroke

Since stroke is considered a complication, a single cause cannot be clearly established for it. Here we are talking more about risk factors that increase the likelihood of this pathology and are divided into two groups:

• modifiable and
• non-modifiable.

The first includes a number of diseases that lead to damage to the vascular wall or deterioration of blood circulation in a different way:

• arterial;
• heart disease;
• flickering;
• transferred in the past;
• disorders of fat metabolism (dyslipoproteinemia);
• diseases that damage the carotid arteries that feed the brain.

Modifiable risk factors include lifestyle features:

• smoking;
• excess body weight;
• malnutrition with a predominance of saturated fats, lack of plant fibers;
• alcohol abuse;
• lack or severe lack of physical activity;
• use;
• decrease in blood testosterone levels;
• acute and chronic.

Non-modifiable factors- this is something that cannot be changed by any methods: gender, age, genetic predisposition.

TO conditionally non-modifiable factors chronic heart failure can be attributed, which, although it can be compensated to certain limits, is completely impossible to cure.

The factors described above relate primarily to ischemic stroke, which is much more common than hemorrhagic stroke. The development of the latter leads to:

• arterial hypertension;
• any pathology of blood vessels supplying the brain;
• violations of the blood coagulation function under the influence of taking anticoagulants, antiplatelet agents, thrombolytics or due to the pathology of the thrombus formation system;
• taking various kinds of psychostimulants - amphetamines, cocaine, etc.;
• alcohol abuse.

Situations that can trigger a stroke

The development of complications is also possible against the background of general well-being, however, often the failure of compensation mechanisms occurs in cases where the load on the vessels exceeds a certain critical level. Such situations can be associated with everyday life, with the presence of various diseases, with external circumstances:

• a sharp transition from a lying position to a standing position (sometimes it is enough to go into a sitting position);
• dense food;
• hot bath;
• hot season;
• increased physical and mental stress;
• cardiac arrhythmias;
• a sharp decrease in blood pressure (most often under the influence of drugs).

Stroke Symptoms

In terms of diagnosis, stroke is a rather difficult task even for doctors. The usual inflammation of the trigeminal nerve, which innervates the muscles of the face, leads to the appearance of some symptoms that are also characteristic of a stroke. If at this moment a person also has an increase, the probability of an error increases significantly.

However, a stroke is a disease in which it is better for a doctor to assume the worst than to miss its occurrence. Therefore, it should be suspected in all cases when:

• there are sudden weakness, numbness, "goosebumps" in the arm, leg, especially if the symptoms appear only in one half of the body;
• facial asymmetry appears;
• vision decreases or disappears, visual artifacts appear that were not there before (loss of part of the field of vision, “flies”);
• speech worsens, becoming incoherent, meaningless;
• for no apparent reason, a severe headache appears, especially if its onset is in the nature of a “hit”;
• consciousness is disturbed from mild stupor, when the patient reacts to external stimuli with a slight delay, until the consciousness is completely turned off - coma.

To simplify the pre-hospital diagnosis of stroke, a group of British doctors developed the FAST complex in 1998. This is a series of simple manipulations, with the help of which in most cases you can at least suspect this pathology.

The essence of this complex is as follows:

1. F-face or face. This element consists in determining the symmetry of the face and identifying the paresis of facial muscles. To identify problems, the patient is offered:
   • Show teeth. With a stroke, the shape of the mouth resembles a tennis racket - one half of the lips moves apart, while the other remains closed.
   • smile. With a stroke, there is a lack of work of facial muscles on one side of the face.
   • Puff out your cheeks. With a stroke, one cheek retains its tone, while the second does not inflate (doctors say "sails", from the word "sail").
2. A-arm or hand. This element is necessary to detect motor and sensory disorders. To detect pathology, the patient is given several tests:
   • The lying patient raises both arms at an angle of 45 ° (sitting - at an angle of 90 °). With a stroke, one of the arms lags behind or does not rise at all.
   • The doctor raises both hands of the patient above his head, connecting them with his palms, holds in this position for 5 seconds, and then releases. One of the hands is gradually lowered.
   • The lying patient is bent both legs in the hip and knee joints at an angle of 90 °. With a stroke, a person cannot hold one of the legs in this position.
   • The patient forms a ring from the index finger and thumb (similar to the OK sign). The doctor inserts his index finger into the ring and tries to break it without much force. If successful, a stroke is suspected.
   • The patient should squeeze the hands of the doctor with both hands. In this case, the difference in the force of compression, inevitable in a stroke, is revealed.
3. S-speech or speech. Allows you to identify violations of speech functions, as well as the ability of a person to navigate in space, time and in his personality. The beginning of the identification of this element is a survey of relatives who could note the moment of occurrence of violations. The doctor then moves on to:
   • What is your name? How old are you? - the patient may not answer these questions if he is not oriented in himself.
   • Where are you at? What date, day, month, year is today? - a patient with a stroke may be disoriented in place, time, space and will not be able to answer correctly.
   • When receiving answers, the doctor pays attention to the delay time with the answer and the intelligibility of speech.
4. T -time or time. This is not an element of diagnostics, but an important stage of medical care. There is a so-called "therapeutic window" - 6 hours from the moment the first symptoms of a stroke appear. This period should be taken into account, since it is at this time that it is possible to carry out such therapeutic measures that can completely eliminate the disease.

Diagnostics

Although the FAST complex makes it possible to establish a diagnosis of stroke with a fairly high degree of certainty (80-90%), a full range of measures is needed to finally confirm this fact. Conducting laboratory and instrumental studies also allows you to determine the tactics of further treatment and make a prognosis regarding the outcome of the disease.

The survey begins with a survey of the patient or his relatives. The doctor pays attention to the moment of the onset of a stroke, reveals the dynamics of the development of symptoms. It is very important to find out all about concomitant diseases that could lead to a stroke, as well as learn about the predisposition to it.

At the second stage, routine analyzes and studies are carried out:

At the third stage, instrumental diagnostics is carried out. Computed and magnetic resonance imaging are used to detect the fact of a stroke, clarify its nature (ischemic or hemorrhagic), the affected area, and also to exclude other diseases with similar symptoms. Sometimes these methods are supplemented with angiography, which allows visualizing the state of the vessels in the area of ​​necrosis and adjacent tissues.

Doppler ultrasound also allows you to find out what condition the vessels of the brain are in, to assess the degree of their narrowing and deterioration of the blood supply to intracranial structures.

Other diagnostic methods provide little data to help doctors, so they are usually not used.

This is the most insidious form of cerebral ischemia (malnutrition). Its danger is that the symptoms characteristic of a stroke occur rather quickly and disappear just as quickly (within an hour). Being not too pronounced, they often pass by the attention of the patient and do not alert him. But even Hippocrates wrote: "Unusual attacks of numbness and anesthesia are signs of impending apoplexy"(apoplexy used to be called all forms of stroke).

Transient ischemic attack is not nearly as harmless as it seems. According to researchers, in the presence of ischemia within half an hour, a third of patients already have organic changes in the brain tissue. That is why when the slightest signs of a stroke appear (even if they disappear after a few minutes), you should immediately consult a doctor to diagnose and prevent circulatory disorders in the brain.

Stroke treatment

Stroke is an extremely serious complication, and therefore its treatment should begin as early as possible. However, drug therapy should not always be applied in the first minutes, as often the rush to prescribe drugs worsens the prognosis of the disease.

The main rule is to call an ambulance, provide first aid if necessary and send the patient to the hospital, where he will be given a full range of therapeutic measures:

• adequate supply of oxygen;
• control of respiratory functions;
• decrease in the severity of cerebral edema;
• elimination of possible fever;
• correction of disturbed metabolic parameters;
• symptomatic treatment.

In addition, specialists may prescribe specific treatment:

• thrombolysis (the introduction of special drugs that dissolve a blood clot in the vessels of the brain);
• anticoagulant and antiplatelet therapy for the same purpose;
• surgical intervention to remove a blood clot, vascular plasty.

Timely treatment of stroke can significantly limit the focus of necrosis of the brain tissue. As a result, a person can avoid death, and in some cases, disability. However, stroke is still an extremely serious pathology, which should be treated only under the supervision of a doctor.

Bozbey Gennady Andreevich, emergency doctor