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With stroke, speed is vital. If you or someone close to
you is having a stroke, call 911 right away for emergency
help. Samaritan’s emergency department is open 24/7/365.
point to a serious problem.
Sometimes, stroke symptoms last for
only a few minutes and then go away
on their own. But that doesn’t mean the
danger is over.
Instead, these transient ischemic attacks
(TIAs)—also called warning strokes—are
o en a sign that a more serious stroke may
occur in the future. In fact, about percent
of people who have an untreated TIA will
have a subsequent stroke, according to the
Society of Interventional Radiology.
Like a full-blown stroke, TIAs should be
considered serious medical emergencies.
Get treatment fast.
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ON-SCENE ASSISTANCE
Once you’ve called
and help is on the way, there are a few things you should do, if you
can, Dr. Alberts says.
First, the person having the stroke should lie down or sit down to avoid a fall. He or she shouldn’t eat, drink or
take any medication—including aspirin—until emergency medical service (EMS) technicians and other personnel
arrive and the person is taken to the hospital.
Also, try to pinpoint when symptoms began. at will help doctors later decide which treatment is best.
Finally, gather all of the person’s medications so you can show them to health care providers. ey’ll need to know every-
thing the person is taking so harmful drug interactions can be avoided.
Once the ambulance arrives, the person is in good hands. EMS workers have lots of experience with stroke. In fact, EMS sta -
ers are the rst medical contact for more than half of all people who have a stroke, according to the National Stroke Association.
Expect EMS workers to ask about symptoms and to take the person’s vital signs, such as blood pressure, pulse and tem-
perature, Dr. Alberts says. Emergency responders will likely also do a quick assessment of neurological function. at might
include checking the person’s ability to move, talk and understand what’s going on, for example.
And, while they’re getting the person ready to move, the EMS team will be in contact with the hospital so people at the
emergency department are prepared for the arrival of a stroke patient.
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EMERGENCY EXPERTS
Once someone who is
having a stroke gets to the emergency depart-
ment, a lot of things will happen very quickly.
For example, hospital personnel will do a
number of assessments. Among other things,
they’re likely to draw blood for tests, do a neurological
exam and perform a brain scan on the patient. A com-
puted tomography (CT) scan is most likely, but sometimes
a magnetic resonance imaging (MRI) exam is done.
ese assessments will help doctors answer two main
questions:
Is the patient actually having a stroke? Other problems like seizures, migraines or heart trouble
can have some of the same symptoms as a stroke.
If it is a stroke, is it ischemic or hemorrhagic?
An ischemic stroke involves a blocked blood vessel in the brain. About percent of all strokes
are ischemic.
A hemorrhagic stroke involves a ruptured blood vessel and bleeding in or around the brain.
“Hemorrhagic strokes are much less common, but they are much more severe in terms of death and
disability,” Dr. Alberts says.
“Depending on how that rst round of assessments goes, doctors should have some idea about the
type of stroke that you have, they should have an idea about how severe the stroke is and then they
should be able to share with you some ideas about treatment going forward,” he says.
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TREATMENT OPTIONS
e two types of strokes are treated
di erently.
When possible, ischemic strokes are treated with a special
drug designed to break up the blood clot and allow blood ow
to resume in the brain.
e medication—called tissue plasminogen activator (TPA)—must be
given within to
½
hours of the rst symptoms of stroke to be safe and
e ective, Dr. Alberts says. is is one reason why getting to the hospital
as soon as possible a er stroke symptoms start is so important.
If it’s too late to give TPA or if there are other reasons why the patient
shouldn’t get it, endovascular therapy may be possible.
For that procedure, a tiny catheter is threaded into the clogged artery and the clot is dissolved with medicine or
removed with a special mechanical device.
To treat hemorrhagic strokes, doctors may use medicines to control high blood pressure or to reduce swelling in
the brain. Sometimes surgery is the best option, depending on the cause of the hemorrhage.
“ e goals of these therapies are to reverse the e ects of the stroke and to reduce whatever de cit the patient is
having in terms of speech, motor function, walking, talking, vision—any of those things,” Dr. Alberts says.
A er treatment, the patient is then admitted to the hospital—o en to a special stroke unit—and monitored for
several days.
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REHAB AND RECOVERY
Finally,
once a stroke survivor is medi-
cally stable and recovering in
the hospital, he or she will be
assessed for rehabilitation.
Rehab is tailored to each patient’s needs,
but the overall goal is the same: reverse as
much of the stroke-caused damage as possible.
Rehab may include work with:
A speech therapist to improve communication skills and memory.
A physical therapist to overcome muscle weakness or paralysis and
improve mobility.
An occupational therapist to help make everyday tasks, such as eat-
ing, bathing and dressing, easier.
A stroke can also a ect a person’s mental and emotional well-being.
Changes in behavior and judgment are possible. So are mood swings
and feelings of anxiety, fear and frustration.
Depression is also possible, and it can pose a special challenge.
“If you are very depressed, it’s likely your participation and motiva-
tion in rehab will be limited,” Dr. Alberts says.
Joining a stroke survivors support group or meeting with a counselor
can help. Some patients also need to take medication for depression.
No matter what type of stroke rehab is recommended, it’s a good idea
to start as soon as possible. Even so, stroke recovery can take weeks or
even years. Some people must cope with lifelong disabilities.
Recovery may also include lifestyle changes, such as:
Avoiding
tobacco.
Eating better.
Managing weight.
Exercising according
to doctor recommendations.
Some stroke survivors also need medications to manage risk factors.
F A L L 2 0 1 2
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T H E
S A M A R I T A N