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

At the prehospital stage it is necessary:

Clear the airways of vomit; introduce an air duct, and, if necessary, mechanical ventilation;

Elevate your head to reduce intracranial pressure and apply ice to your head. If urination is delayed, 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, every minute in Russia someone experiences a cerebrovascular accident - stroke. including micro-stroke. Stroke occurs even more often than myocardial infarction.

The mortality rate from stroke in the first month is 20-25%; in the first year, more than 1/3 of patients die from complications caused by cerebrovascular accidents, and 30-40% become disabled. Such depressing statistics are caused not only by the severity of the disease, but also by untimely (unqualified) assistance provided. Patients who received qualified medical care in the first three hours (maximum 6) have a chance to fully (as far as possible) restore all 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 this diagnosis should be hospitalized - especially if cerebrovascular accidents occurred at work, on the street, or in transport. The doctor, having done a Computerized or Magnetic Resonance Imaging, must determine what is causing the cerebrovascular accident: blockage of blood vessels or hemorrhage. If this is a hemorrhage (Hemorrhagic stroke), then in what place it occurred, it is also necessary to restore the functioning of the vessels as quickly as possible and remove the blood. If there is a blockage in the blood vessels, the doctor will administer a drug that dissolves the blood clot.

The first symptoms of a stroke

The disease progresses individually for everyone. 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, leg;
  • impairment of speech, memory, and 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, or a colleague, this 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 doctor arrives

The patient must be laid down with 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, to do this, remove tight clothing, unbutton your shirt collar, open the 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 in a clean tissue or gauze and clear the vomit from your mouth. Throwing them into the respiratory tract threatens a severe form of pneumonia, which will then be difficult to fight.

Be sure to measure your blood pressure. Previously, it was believed that if it is elevated, it should be reduced to 120/80 mmHg. 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. We need to focus on numbers that exceed the “working” ones by 5-10 mmHg. Art. and give an antihypertensive drug (preferably the one to which the victim is accustomed and 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.

Is there anything to reduce the pressure? Are you afraid of overdosing on your medicine? Don't be alarmed and keep in mind if your blood pressure rises to 180 mmHg. Art. in a person who did not suffer from arterial hypertension, and up to 200 mm Hg. Art. – in a hypertensive patient, this is not very scary. It's better not to adjust it at all. You can resort to non-medicinal methods: ask the patient to take a deep breath and hold his breath for as long as possible. It is very important to measure your pulse. After all, some types of stroke are caused 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 administer any drugs that affect blood vessels and brain structures! The drug glycine (aminoacetic acid) can 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 do any harm and will ease the course of the disease.

If a stroke attack occurs on the street, your steps to help are similar. Ask someone to call an ambulance. Lay the victim down. Make sure that he does not choke on vomit; provide air access by unfastening buttons, belt, belt. The decision is always clear - you need to take him to the hospital. If it is not possible to call an ambulance, deliver the patient by any means of transport, remembering the “therapeutic window”.

If you are using personal transport, then unfold the car seat, lay the patient down (at an angle of 30°), be sure to remove dentures, turn your head to the side and make sure that he does not choke on his own saliva or vomit. Don't forget the tonometer, 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 disorder of cerebral circulation. The arteries supplying blood to the brain may become blocked, and then an ischemic stroke occurs, or the artery may rupture and this is a hemorrhagic stroke. Thus, as a result of this vascular catastrophe, part of the brain is left without normal blood supply and experiences oxygen starvation. As a result of hypoxia - lack of oxygen in tissues, nerve cells die. This leads to a variety of neurological symptoms, this can be complete or partial loss of speech, memory loss, paralysis of body parts (hemiparesis).

Among all strokes, the ischemic variant occurs in 80% of cases. Blockage of the arteries that supply oxygenated blood to the brain 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 clinical picture of such a stroke develops gradually, begins with weakness, dizziness, a feeling of numbness of the face, arms and (or) legs on one side, visual and speech disturbances may appear, the corners of the mouth become asymmetrical, headaches may appear , loss of balance. When a large diameter artery is blocked, it is extremely difficult to differentiate between ischemic and hemorrhagic stroke at the prehospital stage.

A cerebral hemorrhage (hemorrhagic stroke) occurs when a blood vessel ruptures and fills the surrounding tissue with blood. This disrupts the normal flow of blood to the brain, and the released blood puts pressure on the brain tissue, leading to further damage. Most often, hemorrhagic strokes occur against the background of increased blood pressure.

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

What to do

Emergency care for severe stroke at the prehospital stage does not require an accurate determination of its nature (hemorrhage or ischemia). The basic principles of such emergency care are to create conditions for the normalization of vital functions of the body - breathing and blood circulation, combating cerebral edema. Respiratory disorders during loss of consciousness may be caused by obstruction of the airway, which means it is necessary to exclude the retraction of the tongue, the entry of vomit into the trachea and bronchial tree, and for this the patient’s head must be turned to the 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 patients with stroke usually leads to a worsening of its condition and further prognosis.

The patient must be provided with oxygen, and medications with an antihypoxic effect are prescribed. Today, preference is given to the drug Mexidol, which must be administered intravenously, in a dose of 5 milliliters, diluted in saline solution. Of the drugs that improve cerebral circulation, neurologists today recommend the use of magnesium sulfate solution at the prehospital stage. The use of aminophylline for strokes has now been abandoned and is no longer recommended. If there is a threat of cerebral edema, oxygen therapy is continued and 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 measures.

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

Content

Providing competent first aid or self-help in severe acute conditions, which include stroke, requires an extremely responsible attitude. According to statistics, correct actions in such a situation help save the patient’s life and reduce the severity of negative consequences. In all cases, if a stroke lesion is suspected, the first and mandatory step is to call an ambulance.

What is a stroke

An acute disorder of cerebral circulation, in which the movement of blood in one or more areas of this organ is suspended or completely stopped, is called a stroke. This pathological condition threatens death and is fraught with the development of complications - severe irreversible processes that begin as a result of focal brain damage. Properly provided first aid and medical aid can save lives, so every person needs to know what to do in such a situation.

The main causes of stroke are two factors. In the ischemic type, also called cerebral infarction, an obstacle (plaque) of an atherosclerotic or thrombotic nature (thrombosis) forms inside a vessel in the path of blood flow, or another obstacle occurs in the form of a foreign particle (embolism). Hemorrhagic stroke, in which a vascular wall ruptures, occurs against the background of arterial hypertension (high blood pressure), sometimes together with an aneurysm (thinning of a section of the vessel wall).

The development of stroke is promoted by bad habits (alcohol abuse, smoking), excess weight, poor diet (if your diet contains a lot of fatty, fried foods, the likelihood of developing thrombosis is higher). A high risk of cerebral infarction exists in patients with cardiovascular disorders (coronary heart disease, atherosclerosis, hypertension). According to statistics, obesity is a significant provoking factor for women, and alcoholism for men.

First signs

Cerebral infarction (ischemic stroke) and cerebral hemorrhage (hemorrhagic form of the disease) have some differences in typical symptoms. In the first case, the characteristic signs are:

  • dizziness;
  • increasing weakness, numbness of the limbs;
  • speech difficulties;
  • distorted facial muscles, asymmetrical smile (ask to smile);
  • lack of coordination;
  • convulsions;
  • blurred vision, spots before the eyes.

Signs of a hemorrhagic stroke are: sudden headache, paralysis of half the body, disturbance or loss of consciousness, vomiting without a feeling of nausea, drooling, distortion of facial expressions. One-sided paresis or paralysis of the face is possible; a person may not recognize the people and objects around him, or may not remember the day of the week and date. One or a combination of the symptoms described requires immediate emergency medical attention.

Actions for a stroke

For any type of stroke, competent and timely first aid and delivery of the patient to the hospital within three hours from the onset of symptoms, according to statistics, leads to the following positive results:

  • In severe massive strokes with multiple lesions, it saves the patient’s life in 50-60% of cases.
  • In ischemic stroke, it helps improve the recovery abilities of brain cells by 55-70%.
  • In mild cases, it helps to fully recover in 70-90% of cases.

First aid

The first action that must be taken if you suspect a stroke is to call an emergency medical team. This can be done by calling landline 103 or using the emergency number of your mobile operator. Take a couple of minutes of time to calmly and clearly explain to the dispatcher what happened, where you are, and the condition of the victim. Remember the recommendations given to you (if any) and after the conversation ends, proceed to the following actions:

  • Don't panic, act quickly and consistently.
  • Try to calm the patient down. Stress and anxiety can aggravate the condition, so try to convince the victim with your words and clear actions that he will be able to cope with the problem that has arisen.
  • Assess the patient's condition, make sure there is a heartbeat (pulse), breathing and consciousness. Warn the emergency doctors that the victim will require resuscitation measures (artificial respiration, cardiac massage). Lack of consciousness indicates a serious condition and a high degree of brain damage.
  • Place the patient either on his back with his head elevated, or on his side (in case of nausea, vomiting).
  • Provide free access of oxygen to facilitate breathing (open a window, unbutton a tight collar around your neck).
  • Carefully monitor any changes in the victim's condition.

Prohibited actions

Emergency care for a stroke involves not only a set of correct actions, but also the absence of measures that could cause harm to the patient and aggravate his condition. Prohibited activities include:

  • screams, hysterics from someone around;
  • attempts to give food and drink to the victim;
  • in case of loss of consciousness, attempts to revive the person using acid-containing agents (ammonia, etc.);
  • attempts to eliminate the symptoms that have arisen using available medications.

First aid for stroke

First aid for a stroke is provided by the arriving ambulance team. It is recommended to independently give the victim any medications only when the dispatcher makes a one-time clear prescription based on the symptoms described. Emergency measures, which will be carried out by paramedics of the team that arrives to the call, are carried out in order to maintain the vital functions of the body and homeostasis. These include the following manipulations:

  • indirect cardiac massage;
  • artificial respiration;
  • tracheal intubation;
  • injection of blood thinning drugs (for signs of ischemic stroke);
  • administration of anticonvulsants (for convulsive syndrome);
  • injection of cardiac glycosides, diuretics (intravenously);
  • administration of drugs to lower blood pressure (if it rises to critical levels);
  • injection of osmodiuretics (for signs of cerebral edema);
  • administration of thrombus-forming drugs (for hemorrhagic stroke);
  • prompt delivery of the victim to the hospital.

In the hospital, after confirming the diagnosis, the patient is sent either to intensive care (in severe conditions) or to the intensive care ward. Based on laboratory data (computer and magnetic resonance imaging, etc.), the degree of brain damage is determined, and adequate treatment is prescribed aimed at restoring damaged tissues and cerebral circulation.

First aid

Depending on the circumstances under which the victim suffered an attack (on the street or in public transport, at home, in a government institution), providing first aid for a stroke has its own characteristics. The general rule is to call an ambulance if at least one of the characteristic signs of the disease is present, give the patient’s body the correct position, and ensure free access to oxygen.

At home

First aid for a stroke at home or in another enclosed space (shop, office center, etc.) requires the following urgent measures:

  • Be sure to open the window (door, window).
  • Free the victim's neck and chest from tight clothing.
  • Measure your blood pressure.
  • Place the patient on his back or side (if he is vomiting), elevate his head, and if the pressure is reduced, his legs (without lowering his head).
  • You can lightly massage the carotid artery area on both sides of the neck.

On the street

If the incident happened on the street, providing first aid to the victim has its own characteristics. It is advisable to involve several volunteers in the event of an incident, distribute responsibilities, and act harmoniously and according to a clear plan (someone will call the ambulance, others will provide assistance). The general scheme of procedures remains traditional:

  • The patient should be placed in the correct position.
  • Free the person’s neck and chest from compressive clothing items (tie, collar, scarf).
  • In cold weather, you need to cover the patient with warm clothes.
  • If possible, you should take the victim’s mobile phone to inform relatives about the incident and direct them to the hospital where he will be hospitalized.

With ischemic

Features of assistance for ischemic stroke include giving the body a position in which the head and shoulders will be located at a slight angle to the body. To improve blood flow, moisten the victim’s face with a damp cloth and lightly massage or rub the limbs with a soft brush. Carefully observe that breathing is maintained and do not let the tongue fall into the throat (turn the patient’s head to the side). Cover your feet.

For hemorrhagic

First aid for suspected hemorrhagic stroke requires prompt, clear action, since the patient’s condition quickly deteriorates. The recommended body position is on your back, with your head turned. Cold may be applied to the non-numb (non-paralyzed) part of the head. To ensure an influx of fresh air, open a window and unfasten constrictive clothing. The oral cavity is cleaned of saliva and vomit, and dentures are removed (if any). The victim's feet are placed in a warm place, rubbing with alcohol or oil.

Self help

In case of a stroke, first aid to yourself is limited by the severity of the condition. In most cases, pathology occurs acutely, suddenly. If you experience symptoms resembling an illness, you must do the following:

  • Tell someone close or familiar that you feel bad, and ask for help.
  • Call an ambulance.
  • Take a horizontal position with something under your head.
  • Try not to worry and not make sudden movements.
  • Free your chest and neck from constrictive clothing.

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First aid for a stroke is very important as it can save the patient's life. If there are signs of apoplexy, you should urgently call an ambulance.

It is dangerous to delay this, because with a stroke every minute is precious. The faster help is provided, the less likely it is that dangerous consequences will develop.

How to tell if someone is having a stroke

You can suspect a severe cerebral circulatory disorder based on the following signs:

  • a sharp increase in blood pressure;
  • drowsiness, weakness, fatigue;
  • severe dizziness;
  • severe pain in the head area;
  • feeling of heat or cold.

If the following signs appear, you should urgently call an ambulance:

  • sharp pain in the head area;
  • numbness of a limb or half of the face;
  • loss of coordination or balance;
  • diplopia (double vision);
  • sudden disturbance of heart rhythm;
  • impairment of speech and ability to understand others;
  • distortion (asymmetry) of facial expressions;
  • vomiting or nausea.

How to understand what kind of stroke has occurred

There is ischemic and hemorrhagic stroke. Both types of blows are extremely dangerous for humans and are fatal if first aid is not provided.

With hemorrhagic, bleeding occurs in the brain. It is characterized by the following first signs:

  • a sharp increase in blood pressure;
  • acute onset;
  • rapid deterioration of condition;
  • rapid development of coma;
  • pallor (or redness) of the face, increased body temperature;
  • the appearance of paralysis.

Ischemic stroke often occurs against the background of diabetes, coronary artery disease, or a previous heart attack. Symptoms of cerebral circulatory disorders increase gradually. The disease can manifest itself against the background of low blood pressure, which is very dangerous in diagnosis and the timing of first aid.

What is the UZP test

You can help a person by offering him:

  • smile (cause for alarm - distorted lips);
  • speak (with a stroke, the patient does not understand speech addressed to him or speaks with errors);
  • raise your arms (with a stroke, a person cannot do this with both limbs at the same time).

First aid scheme

When calling an ambulance, you should clearly indicate all the symptoms observed in the victim. If the waiting time for an ambulance is too long, then you should try to transport the patient to the hospital intensive care unit yourself. The patient should be placed in the back seat.

Indoor activities

A stroke can catch a person indoors. Those around you should adhere to the following scheme for providing first aid at home:

  1. Lay the person horizontally. It happens that he loses consciousness and falls. He needs to be left in this position and monitored for spontaneous breathing.
  2. If the latter is violated, you need to turn the patient on his side. In this case, there is no need to transfer it.
  3. To make breathing easier, it is important to free your body from tight and uncomfortable clothing. To do this, unfasten the belt and provide air flow.
  4. If you have a tonometer, you need to measure your pressure and record its readings. The information obtained from the measurement will be very important for the doctor.
  5. The victim needs to be reassured and be with him until the doctors arrive.
  6. It is imperative to prepare documents and record important nuances, for example, the presence of an allergic reaction to certain medications.
  7. If the lungs or heart stop working, it is necessary to urgently begin indirect massage of the latter and artificial respiration.

Activities on the street or in a vehicle

If you find a person with symptoms of apoplexy, you should urgently call doctors. Before the ambulance arrives, a set of the above measures is immediately started.

If the victim is on a train or subway, then you need to call the attendants. All employees know the basic techniques for providing emergency medical care, and this will help preserve the health and life of the patient.

If a stroke occurs on the street in a crowded place and the victim has a lot of onlookers, then measures must be taken to ensure that they make way. When providing medical care, panic is extremely dangerous because it can worsen the patient's condition.

What to do if a person loses consciousness

In case of sudden loss of consciousness, the following algorithm should be followed:

  • lay on your back without using anything as a pillow;
  • the head must be turned so that the tongue does not interfere with breathing;
  • access to sufficient oxygen should be ensured;
  • You can splash your face with cold water;
  • calm the patient down.

Actions for hemorrhagic stroke

If a person exhibits signs of paresis of the facial nerve, impaired movement in the limbs, one part of the body, and a difference in the size of the pupils is detected, then he is highly likely to develop a hemorrhagic stroke. The same can be assumed if there is severe pain in the head, nausea and vomiting.

The immediate measures in this case will be:

  • urgent call for an ambulance;
  • placing a person on a flat horizontal surface;
  • ensuring a flow of fresh air;
  • tilting the head back in case of convulsions to prevent vomit from entering the respiratory tract.

In case of hemorrhagic stroke, the use of any medications is strictly prohibited. In most cases, surgery is used as treatment. It is necessary to ensure timely transportation of the victim to the clinic.

The sooner you seek help from doctors, the more favorable the treatment outcome will be.

Actions for ischemic stroke

This type of stroke develops gradually. Precursors of the disease are disturbances in speech, memory, sensitivity, and weakness throughout the body.

When such signs appear, the action algorithm will be as follows:

  • emergency call;
  • restoration of airway patency (to do this, you need to tilt your head back and push your lower jaw forward);
  • cleansing the respiratory tract from vomit;
  • freeing the chest from constricting clothing;
  • blood pressure measurement;
  • raising the patient's head and torso by 20 cm to prevent cerebral edema;
  • carrying out and artificial respiration as necessary.

If convulsions occur, care must be taken to ensure that the person does not bite his tongue. To do this, a piece of durable fabric rolled into a roll is inserted between the teeth. During convulsions, hold the head, making sure that the person does not hit himself.

Prohibited actions

During an apoplexy, the following actions are completely unacceptable:

  • Expectation of improved health. This will not happen with a stroke. Meanwhile, the first hours after a cerebral circulatory disorder are critically important for resuming the basic functions of the nervous system and minimizing the risk of disability for the patient.
  • Use of medications. It is not allowed to give antihypertensive or hypertensive medications, even those medications that the patient regularly takes as prescribed by the doctor.
  • Give water or food to the victim. At any moment, such a person may begin to vomit.
  • Revive the patient using ammonia and similar drugs. They can significantly impair respiratory function.

Transporting a patient with a stroke

Transporting a patient with a stroke requires compliance with special rules. In some cases, especially if there is a suspicion of a hemorrhagic stroke, it becomes impossible to travel in a regular car.

From the first minutes after a brain injury, the patient needs intensive care. It is impossible to provide it in a regular vehicle. For such purposes, only an ambulance is used. This type of vehicle is equipped so that emergency assistance can be provided on the way to the hospital.

Only medical workers can transfer the patient. Even one careless movement when a stroke is suspected can cost a person his life.

Doctor's tactics

The first 3-6 hours after the onset of a stroke are the so-called therapeutic window. The doctor’s actions are aimed at preventing the death of parts of the brain and the formation of foci of tissue necrosis in it. For this, symptomatic treatment is carried out.

If necessary, tracheal intubation, closed cardiac massage, and artificial ventilation are performed. For convulsive syndrome, anticonvulsants are administered. Osmodiuretics need to be injected as cerebral edema progresses.

Medical care also includes measures to stabilize blood pressure.

This can be achieved by:

  • administration of antihypertensive drugs and diuretics;
  • drugs that stimulate the heart;
  • correction of water-salt metabolism, protein levels, blood sugar;
  • relieving symptoms of the disease by using anticonvulsants and painkillers.

It is mandatory to take preventive measures to prevent relapse of the pathology.

First aid for acute cerebrovascular accident should begin as early as possible. The outcome of the disease and the restoration of the patient’s body functions depend on this. All resuscitation measures must be carried out harmoniously and without panic. This way the recovery of the victim can be guaranteed.


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


Stroke: lost time = damaged brain cells

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

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

2. How to recognize a stroke?

Signs of a stroke may include one or more of the following:
■ weakness, paralysis (inability to move), or numbness of the face or limbs on one side of the body;
■ sharp deterioration of vision, blurred images, especially in one eye;
■ unexpected speech difficulties, slurred speech, sinking tongue, tongue deviation to one side;
■ unexpected difficulties in understanding speech;
■ sudden difficulty swallowing;
■ unexplained falls, dizziness or loss of balance. Attention: if a person has not drank alcohol, but behaves “like a drunk,” this symptom may indicate the development of a stroke. The presence of alcohol intoxication also does not exclude the development of a stroke. Be more attentive to people who look “drunk” - maybe you can save someone’s life!
■ sudden severe (the worst of your life) headache or a new unusual type of headache without a specific cause;
■ drowsiness, confusion or loss of consciousness.

A person without medical training can use a simple pre-hospital test for assessing the likelihood of stroke using the Cincinnati scale:

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

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

IMPORTANT:
There is a condition called transient ischemic attack, where the blood supply to the brain is temporarily interrupted, causing a “mini” stroke. Even if the observed symptoms of a stroke were mild and went away after a certain period of time, the tactics of action should be exactly the same as for a “big” stroke: place the patient in a position that is safe for vomiting, ensure his immobility and immediately call an ambulance. A “mini” stroke can be a precursor to the development of a “big” stroke.


First aid for stroke.

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

"Russian" features of calling and interacting with the ambulance team:

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

1. If you are very likely to be sure of the diagnosis, call the ambulance that the patient is having a stroke and requires the arrival of a neurological team. To the question "How do you know about the diagnosis?", in a confident voice, inform that the diagnosis was made by a neighbor doctor or a relative doctor and demanded that you immediately call a neurological ambulance team. According to statistics, an ambulance dispatcher is able to correctly determine the diagnosis of “stroke”, taking into account the caller’s confusing story, only in 1/3 of cases. The arrival of a regular ambulance rather than a neurological one can lead to a loss of time before the start of medical care in a hospital. During negotiations with the ambulance, someone must be with the patient at all times!

2. Send someone to your neighbors for help: you will need 2-4 strong men to carefully carry the patient on a stretcher from the house to the ambulance. If you have not yet encountered Russian ambulance, then you should know that not in all, but in many cases doctors, paramedics, nurses, drivers ambulance workers (at least in St. Petersburg) refuse to carry patients on stretchers into the ambulance, arguing "that this is not their responsibility" or "they're not strong enough", or they demand money for carrying patients. Any delay plays against the patient: prepare your porters in advance. Don't get into conflict with ransomware- you may lose valuable time providing medical care. Agree to their terms: remember that life and health are much more important than money. It will be possible to deal with the extortionists after the patient’s condition is stabilized in the hospital. To do this, ask one of your family members or neighbors to be present at the “bargaining” and discreetly record the fact of extortion of money on a mobile phone (video, voice recorder) and later contact the police with these materials: outright lawlessness taking advantage of the helpless situation of patients must be fought.

The responsibilities of doctors, paramedics and ambulance drivers to transfer patients to the ambulance are recorded in the appendices to Order No. 100 of the Ministry of Health of the Russian Federation dated March 26, 1999
Appendix No. 9 Regulations on the doctor of the mobile emergency medical team: The doctor is obliged (clause 2.3) Ensure gentle transport with simultaneous intensive therapy and hospitalization of the patient (victim).
Appendix No. 10 Regulations on the paramedic of the mobile emergency medical team: The paramedic is obliged (clause 2.7) Ensure that the patient is carried on a stretcher, if necessary, take part in it (under the working conditions of the team, carrying a patient on a stretcher is regarded as a type of medical care in a complex of medical measures). When transporting a patient, be next to him, providing the necessary medical care.
Appendix No. 12 Regulations on the driver of the ambulance team: Responsibilities of the driver: (clause 2.5) Provides, together with the paramedic (paramedics), carrying, loading and unloading patients and victims during their transportation, assists the doctor and paramedic in immobilizing the limbs of victims and applying tourniquets and bandages, transfers and connects medical equipment. Provides assistance to medical personnel accompanying mentally ill patients.

For those who don’t believe that the ambulance doctors in St. Petersburg “don’t know how” and “don’t want” to carry patients on stretchers, I suggest watching the latest video from CCTV cameras showing how a patient with a criminal closed craniocerebral injury (according to the press, the victim Denis was beaten in the entrance) “medics” carry him to the “ambulance”:

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

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

5. Upon arrival at the hospital emergency department, contact your friends with whom you have previously telephoned, or, if you do not have them, the responsible doctor and explain that the patient has a stroke, and every minute is needed before medical care begins (remember the 3-hour rule from the onset of stroke). Tell them that the life and health of the sick person are dear to you and you will pay for the immediate start of diagnosis and medical care. Otherwise, in the evening, in hospitals in large cities, such as St. Petersburg, the waiting time in the emergency room before medical care begins can be 3-5 hours, which will lead to irreversible impairment of the patient’s brain function during a stroke, despite the fact that that care for stroke should begin as a priority, just as, for example, for myocardial infarction.

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

What to do before the ambulance arrives?

The main tasks of loved ones and relatives before the ambulance arrives at a stroke patient:
■ Maintaining airway, breathing and circulation.
■ Prevention of complications.
■ Reducing the severity of stroke consequences.
■ Preparation of documents (passport, medical insurance) and important information about the patient (chronic diseases, drug intolerance).

1. Reassure the patient, let him know that you are looking after him, and that an ambulance will arrive soon. If a stroke patient is not in contact with you due to confusion, this does not mean that he does not hear or understand you. The lower the patient's stress/anxiety level, the greater the chance of a better outcome.
2. Do not give the patient anything to drink or eat. Do not give the patient any medicine.
3. Place the patient on a horizontal surface. The less the patient moves, the less chance there is of increased bleeding (if any), blood clot rupture, or vasospasm. If the patient is conscious and there is no vomiting, then he can be laid on his back. You should not raise your head and shoulders: a horizontal position of the head ensures better blood supply to the brain. Remove dentures and food debris from your mouth. You can raise your legs a little - this will improve blood flow to the head. Do not allow the patient to move.

Vomit:

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

Providing a safe position for the patient on his side:

Kneel next to the person. Turn him on his side to face you. Extend his lower arm forward at a right angle. Bend his top leg at the knee, keeping the other leg straight. The bent leg should rest with the knee on the surface. Tilt your head and neck slightly back and down so that the contents of your mouth (if any) can flow down freely. Pull your jaw down and check the airway with your finger. Remove any remaining food or vomit. Hold his jaw so that his mouth is open at all times. Check for free breathing: is there movement of the chest? Do you feel, when you lean your neck towards the patient’s face, his exhalation? Can you hear his breathing?

If there is no breathing, it is urgent to begin cardiopulmonary resuscitation (artificial respiration and chest compressions).

Provide a dish or towel for vomit. When vomiting, turn and hold your head down to drain the vomit and prevent inhalation. Use your finger to clear your mouth of any remaining vomit.

Oxygen access:

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

Controlling blood pressure:

In most cases, blood pressure increases during the acute period of a stroke. On the one hand, increasing blood pressure is a compensatory means to improve blood supply to the brain. On the other hand, high blood pressure increases the risk of recurrent stroke and worsening the patient's condition. If you can monitor the patient's blood pressure using a tonometer, it is recommended to maintain the following blood pressure values ​​in a patient with a stroke in the acute period:
in patients with hypertension: 180/100-105 mm Hg
in patients without hypertension: 160-180/90-100 mm Hg
Reducing blood pressure with medications without a doctor is strictly prohibited!

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

You cannot apply ice (cold) to the head or the back of the head - this can worsen the blood supply to the brain!

4. Reflexotherapy and micro-bleeding for acute stroke*

For stroke the point is actively massaged with force for 3-5 minutes (rubbed, pressed, punctured with a fingernail), or burned with a cigarette (from a distance of several cm) GI3 san-jian and period V62 shen-may(massage only).

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

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

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

When blood pressure rises points are additionally punctured PC86 II and III fingers of each hand.

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

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 elapsed between the peak of the attack and the provision of medicinal care in the hospital. A stroke victim, the people around him and doctors have no more than 4 hours to restore blood flow to the brain. Therefore, promptly provided first aid for a stroke is extremely important; during this period it is necessary to recognize the attack by its 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.

A stroke and the nature of its development mechanism can be recognized by a set of general neurological and specific symptoms in order to provide first aid in a timely manner. Common primary symptoms 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;
  • short-term attacks of amnesia;
  • speech disorder.

Manifestations ischemic stroke have their own characteristic features:

  • paralysis of the body or limbs develops on one side, almost always the opposite side of the damage to the brain cells;
  • the gait becomes uncertain and shaky, often the victim cannot stand on his own feet;
  • speech becomes difficult, articulation and perception of what is said decreases;
  • occurs, accompanied by bouts of vomiting.

I'm about to attack hemorrhagic stroke quite often preceded by a sharp increase in blood pressure - a hypertensive crisis. As a result, the artery ruptures and hemorrhages into the brain tissue. During an attack, a person experiences:

  • sharp and unbearable pain that feels like it’s tearing your head apart;
  • increased heart rate;
  • facial distortion due to increased muscle tone;
  • paralysis;
  • high sensitivity to light, dots and blurry circles before the eyes.

Signs that allow a definitive diagnosis of a stroke before doctors arrive include:

  • asymmetrical smile and inability to lift 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, in the event of a sudden deterioration in a person’s health, at least a few of the described signs are detected, an emergency ambulance should be immediately called and taken to the hospital.

At the first signs of a stroke, despite the victim’s consciousness and his assurance that everything is in order, people nearby should promptly call an ambulance and describe 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:

Is something bothering you? Illness or life situation?

  1. In case of special instructions from the dispatcher, follow them unquestioningly.
  2. Carefully place the victim in a position in which the head is elevated to 30° and slightly turned to one side. This is necessary so that in case of sudden vomiting, food debris does not enter the respiratory organs, and also in case of loss of consciousness, the tongue does not stick.
  3. Open a window or vent to allow fresh air into the room where the victim is located.
  4. Calm the patient if he is overexcited or begins to get nervous due to limited mobility. It should be explained in a calm tone that he will soon receive medical assistance to alleviate his condition.
  5. Measure your blood pressure and, if possible, your sugar level and record the results of the measurements so that you can inform your doctors later.
  6. Remove or unfasten clothing items that are squeezing your throat, chest, or belt.
  7. In the absence of consciousness, breathing and heartbeat, immediately perform indirect cardiac massage and artificial respiration.

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

Also, if there is severe facial asymmetry, the patient’s earlobes are intensively rubbed, and then 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 actions that forbidden to perform if a stroke is suspected include:

  • strong shaking of the victim, sudden movements, screams and hysterics of others;
  • feeding and drinking plenty of fluids;
  • bringing to life with ammonia and other acid-containing agents;
  • attempts to eliminate the symptoms of brain failure independently with pharmaceuticals;

First aid for stroke

Before the ambulance team arrives, it is not recommended that the victim be given any medications on his own, except in cases where the ambulance dispatcher can make a one-time prescription based on the described symptoms.

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

  • indirect cardiac massage;
  • artificial respiration;
  • tracheal intubation;
  • administering blood thinners for symptoms of ischemic stroke;
  • administration of anticonvulsants for severe convulsive syndrome;
  • reducing blood pressure with medications if its levels are critically elevated;
  • administration of osmodiuretics if the victim shows signs of cerebral edema;
  • administration of thrombus-forming agents if a hemorrhagic stroke is diagnosed;
  • administration of drugs that improve blood flow through blood vessels and arteries.

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