Understanding the Stroke- First Aid Treatment and the Mandatory Protocols

When a person is having a stroke, every second counts. And what you do in those critical moments can potentially help save someone’s life.

Jean D. Luciano, CRNP, Stroke Team Co-director of the Comprehensive Stroke Center at Penn Medicine and a nurse practitioner at the Penn Medicine Neuroscience Center, spells out important do’s and don’ts, so you can be ready to give your loved one the best chance of surviving a stroke.

A stroke is often described as a “brain attack.” Part of the brain is robbed of the oxygen and blood supply it needs to function, because a blood vessel to part of the brain either has a clot or bursts.

The longer a stroke goes untreated, the more brain damage can occur. But there are treatments that can be given if a person reaches the hospital in time.

3 THINGS TO DO WHEN SOMEONE IS HAVING A STROKE

1. Call the authorities immediately

If you do nothing else, act quickly to call the authorities.

“The hardest thing you have to do is recognize symptoms of a stroke,” Jean explains. “If you do observe any symptoms, you should call the authorities immediately. You should also immediately tell the dispatcher, ‘I think I’m having a stroke’ or ‘I think my loved one is.’”

Not sure what the symptoms of a stroke are? Give someone you think is having a stroke this FAST test from the National Stroke Association.

2. Note the time you first see symptoms

A clot-busting medication called TPA, or tissue plasminogen activator, can be given to someone if they’re having a stroke, potentially reversing or stopping symptoms from developing. But it has to be given within 4.5 hours of the start of symptoms, Jean says. Patients may also be candidates for more advanced therapies, such as endovascular treatments, at Penn Medicine. Endovascular treatments can involve surgically removing a clot that caused a stroke, or fixing an aneurysm— which is a swollen blood vessel that bursts and causes pressure in the brain. Endovascular treatments for ischemic stroke, the most common type of stroke, must be administered within 24 hours of symptom onset, and earlier treatment improves outcome so time is critically important.

“If a witness sees someone having a stroke, it would be helpful if they look at what time the symptoms started,” she says. “That way, the emergency staff can make a more informed decision about treatment options.”

3. Perform CPR, if necessary

Most stroke patients don’t require CPR, Jean notes. But if your friend or spouse is unconscious when you find her, check her pulse and breathing. If you find none, call the authorities and start CPR while you’re waiting for the ambulance to arrive.

You can also ask the official dispatcher to walk you through how to perform CPR, which consists of repeated, steady chest compressions, according to the American Heart Association

3 THINGS NOT TO DO WHEN SOMEONE IS HAVING A STROKE

1. Do Not Let that person go to sleep or talk you out of calling the authorities

Stroke survivors often complain of suddenly feeling very sleepy when a stroke first happens.

“A lot of patients come in and say they went to sleep for a few hours before they came to the hospital because they were tired,” Jean notes.

But time is of the essence. “The medication we can give a stroke survivor is time-sensitive,” she adds. “They should not go to sleep, and they should not call their primary care doctor 2 days from now. Instead, they should just go immediately to the emergency room.”

And no matter how much someone might try to talk you out of taking them to the hospital, don’t let them, says Jean.

2. Do Not Give them medication, food, or drinks

There are 2 kinds of strokes:

■ Hemorrhagic stroke, caused by a ruptured blood vessel

■ Ischemic stroke, caused by a clot in a blood vessel “80% of strokes are ischemic ones, but if you’re in that 20% and your stroke was caused by a ruptured blood vessel in the head, you don’t want the victim to have aspirin,” Jean says. “And you can’t tell which one it is until you get to the emergency room and you get a CAT scan.”

To be safe, don’t give someone who has a stroke any medication. You also shouldn’t give him food or drinks before the ambulance comes. “Sometimes, a stroke affects their ability to swallow,” Jean says.

3. Do Not Drive yourself or someone else to the emergency room

It might seem like a good idea to drive a stroke victim to the nearest emergency room. But Jean says, “If someone is severely affected by a stroke, then you’re better off calling the authorities.” Emergency responders can start life-saving treatment for that person on the way to the emergency room, the Centers for Disease Control and Prevention (CDC) says.

You also don’t want to drive yourself to a hospital in the event that your stroke symptoms worsen and impair your ability to drive safely.

STAY FOCUSED AND TAKE ACTION QUICKLY

As frightening as it can be to witness someone having a stroke, taking a few key steps—and avoiding others—can potentially help your loved one have the best possible outcome. “We have a process in place to treat someone who is having a stroke critically once they get here,” Jean notes. “But they really need to get here as quickly as they can.”

THE SYMPTOMS THAT COULD MEAN YOU’RE HAVING A STROKE

The symptoms of a stroke can vary from patient to patient. But they tend to have one thing in common: They take people by surprise, says Michael Mullen, MD, Assistant Professor of Neurology at Penn Medicine.

“Stroke symptoms come on very suddenly,” he says. “People are fine one moment and then suddenly have symptoms, such as weakness, numbness, trouble talking, or loss of vision. They might wonder where it came from.”

What’s happening? A stroke occurs when the blood’s flow to the brain is blocked, or a blood vessel in the brain ruptures.

Without blood, brain cells start to die, and the functions controlled by that area of the brain—such as speech or muscle movement—are impaired or lost, the National Stroke Association says.

The effects can cause permanent brain damage and disability, depending on how severe the stroke was and how quickly the patient is able to get help.

WHAT DOES A STROKE FEEL LIKE?

Strokes can carry a number of sudden, telltale symptoms, Dr. Mullen says. These include:

■ A droop on 1 side of the face

■ Difficulty lifting 1 arm to its full height

■ Slurred speech or difficulty with talking

■ Impaired vision in 1 or both eyes

■ Vertigo

■ Difficulty walking

The American Heart Association/ American Stroke Association notes that a sudden severe headache that does not appear to be triggered by anything is another potential sign that you might be having a stroke. Quite often, though, strokes are painless, which can surprise people, Dr. Mullen says.

“Although some strokes are associated with a headache, many occur without any accompanying pain,” he says. “This doesn’t mean you’re not having a stroke. If you’re having symptoms of a stroke, you need to get medical care immediately.”

EVEN IF SYMPTOMS VANISH QUICKLY, CALL FOR HELP

You should also be aware that warning signs might last only for a few minutes before they disappear. These brief episodes are transient ischemic attacks (TIA) or “mini-strokes.” They still should be taken seriously, because they tend to be signs of underlying serious conditions.

“It’s not uncommon for people who have had a TIA to ignore it because they don’t know what it was,” Dr. Mullen says. “But people who have TIA symptoms are definitely at higher risk of having a subsequent stroke, and they need to be evaluated.”

Once you recognize that you or someone you witness is having a stroke, the next step is calling the authorities quickly, Dr. Mullen stresses.

Time is critical if someone is having a stroke. The longer a stroke goes untreated, the more damage can be done—possibly permanently—to the brain.

“If you suspect you or someone you’re with is having a stroke, don’t hesitate to call the authorities,” Dr. Mullen says. “It could save their life.”

The Penn Stroke Center is a Joint Commission-certified Comprehensive Stroke Center. Patients who have suffered a stroke have access to the most advanced resources available for the treatment of stroke 24 hours a day, 7 days a week, 365 days a year.