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 IN RESUSCITATION).

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

3. For hemorrhagic stroke products with hemostatic and angioprotective properties are indicated. The drug of choice for this purpose is dicinone (synonyms: etamsylate, cyclonamide). The hemostatic effect of dicinone when administered intravenously begins within 5-15 minutes. the maximum effect occurs after 1-2 hours, the effect lasts 4-6 hours or more. 2-4 ml of 12.5% ​​solution is administered intravenously, then 2 ml every 4-6 hours. Can be administered intravenously by drip, adding to conventional solutions for infusion (M. D. Mashkovsky, 1997).

4. For normalization of blood pressure at the emergency stage, you can use intravenous injections of dibazole (2-4 ml of 1% solution), clonidine (1 ml of 0.01% solution), droperidol (2-4 ml of 0.25% solution) . If there is no effect, ganglion blockers are indicated - pentamine (1 ml of 5% solution) or benzohexonium (1 ml of 2.5% solution), but the administration of these drugs must be done with caution and constant monitoring of blood pressure.

5. Due to the sharp increase fibrinolysis cerebrospinal fluid, epsilon-aminocaproic acid is indicated 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 the topic CEREBRAL EDEMA.

7. Relief of hyperthermic syndrome(if available); 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 (bedsores).

10. Control of intestinal 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 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 normal subsequent restoration of body functions.

Types of strokes:

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

Stroke - symptoms and first aid

Signs of hemorrhagic stroke:

1. Sharp severe headache.
2. Hearing loss.
3. Vomit.
4. Paralysis of limbs.
5. Distorted facial expressions.
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. Numbness of the face.
5. Headache.
6. Dizziness.
7. Loss of coordination.
8. Deterioration of vision.
9. Cramps.

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

Emergency care for stroke

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

Hemorrhagic stroke - first aid:

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

First aid for ischemic stroke:

Emergency care for strokes

Strokes are acute circulatory disorders in the brain (cerebral) and spinal cord (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 (cerebral 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 venous thrombosis, hemorrhagic cerebral infarction often develops; IV - combined strokes, when there are simultaneously areas of softening and foci of hemorrhage.

Transient cerebrovascular accidents (TCI) are 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 region). This option includes only those observations in which general cerebral and focal neurological symptoms disappear after 24 hours.

Symptoms. Characterized by general cerebral and focal disorders. General cerebral symptoms include headache, non-systemic dizziness, nausea, vomiting, noise in the head, possible disturbances of consciousness, psychomotor agitation, and epileptiform seizures. General cerebral symptoms are especially characteristic of hypertensive cerebral crises. Hypotonic crises are characterized by less pronounced cerebral symptoms and are observed against the background of low blood pressure and weakened pulse.

Focal symptoms most often manifest themselves in the form of paresthesia, numbness, tingling in local areas of the skin of the face or limbs. Motor disorders are usually limited to the hand or only to the fingers and paresis of the lower facial muscles, speech disturbances, dysarthria are observed, deep reflexes in the limbs increase, and pathological signs appear. In cases of stenosis or occlusion of the carotid artery, 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 pulsation on one side), and a systolic blowing noise is heard during auscultation. If there is a circulatory disorder in the vertebral-basilar system, darkening before the eyes, dizziness, coordination disorders, nystagmus, diplopia, and impaired sensitivity in the face and tongue are characteristic. Transient disturbances in the large radiculomedullary arteries are manifested by myelogenous intermittent claudication (when walking or physical activity, weakness of the lower extremities, paresthesia in them, and transient dysfunction of the pelvic organs, which resolve independently after a short rest), appear.

Diagnostics. When examining a patient, it is impossible to immediately determine whether the present cerebrovascular accident will be transient or persistent. This can be concluded only after 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 different therapeutic measures. For atherosclerotic cerebrovascular insufficiency, cardiotonic drugs are used (1 ml of 0.06% corticone solution or 0.025% strophanthin solution is administered intravenously with glucose, 10% sulfocamphocaine solution 2 ml subcutaneously, intramuscularly or slowly intravenously, 1 ml of cordiamine subcutaneously), vasopressor (in case of a sharp drop in blood pressure, 1 ml of 1% solution of mezaton, 1 ml of 10% solution of sodium caffeine benzonate is administered subcutaneously or intramuscularly) to improve cerebral blood flow (10 ml of 2.4% solution of aminophylline intravenously slowly with 10 ml saline solution, 4 ml of 2% papaverine solution intravenously, 5 ml of 2% trental solution in a dropper with saline solution or 5% glucose) drugs. Sedatives are prescribed (bromocamphor 0.25 g 2 times a day, motherwort tincture 30 drops 2 times a day) and various symptomatic drugs 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 vessel rupture occurs with arterial hypertension and local defects of the vascular wall (atherosclerotic plaque, aneurysm, etc.). Intracerebral hematoma is most often localized in the area of ​​the subcortical ganglia and internal capsule. Less commonly, a primary hematoma forms in the cerebellum and brain stem.

Symptoms. Hemorrhagic stroke of any location is characterized by general cerebral symptoms: severe headache, nausea and vomiting, bradycardia, rapid depression of consciousness. Focal symptoms depend on the location of the hemorrhage. More often, hemorrhagic stroke develops in middle-aged and elderly people and occurs suddenly, at any time of the day. The patient falls, loses consciousness, and vomits. On examination, the face is purple, the breathing is snoring (stertorous), urinary incontinence. Blood pressure is often elevated. Considering the predominance of the lesion in the internal capsule of the brain, hemiplegia and hemihypesthesia can also be detected when the patient is unconscious. If blood breaks into the subarachnoseal space, meningeal symptoms occur. When blood breaks into the ventricles of the brain, hormetonic convulsions develop, disturbances of consciousness deepen to the point of atonic coma, pupils dilate, body temperature rises, breathing problems increase, tachycardia increases, and after a few hours death can occur. Subarachnoid hemorrhage usually develops suddenly (rupture of an aneurysm), with physical stress: a severe headache occurs, sometimes radiating along the spine, followed by nausea, vomiting, psychomotor agitation, sweating, ophthalmic symptoms, and depressed consciousness.

Diagnostics. Based on characteristic clinical symptoms and cerebrospinal fluid examination data.

Urgent Care. For hemorrhagic stroke, the following are necessary: ​​strict bed rest, stopping bleeding, reducing blood pressure to normal, reducing 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, observing all precautions: carefully placing the patient on a stretcher and bed, maintaining a horizontal position when carrying, avoiding shaking, etc. Before transportation, the patient is administered hemostatic agents (vicasol , dicinone, calcium gluconate), apply a venous tourniquet to the thighs to reduce the volume of circulating blood. In case of threatening respiratory failure, transportation with IVP and oxygen inhalation are advisable. In the early stages, administration of epsilon-aminocaproic acid (100 ml of 5% solution intravenously) with 2000 units of heparin is indicated. To reduce intracranial pressure, active dehydration therapy is carried out: Lasix 4-6 ml of 1% solution (40-60 mg) intramuscularly, mannitol or mannitol (200-400 ml of 15% solution intravenous drip). the earliest possible use of means of “metabolic protection” of brain tissue and antioxidants is justified (sodium hydroxybutyrate 10 ml of a 20% solution intravenously slowly - 1-2 ml per minute; piracetam 5 ml of a 20% solution intravenously; tocopherol acetate 1 ml 10-30 % solution intramuscularly; ascorbic acid 2 ml of 5% solution intravenously or intramuscularly. Fibrinolysis inhibitors and proteolytic enzymes are also administered in the early stages: Trasylol (contrical) 10,000-20,000 units intravenously.

It should be remembered that the development of spontaneous subarachnoid hemorrhage in young people is often caused by 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, hypercoagulation, etc.).

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

Urgent Care. Basic principles: inhibition of thrombus formation and lysis of fresh thrombi, limitation of areas of ischemia and perifocal cerebral edema, improvement of cardiovascular system function, elimination of acute respiratory disorders. In case of thrombosis or thromboembolism of the vessels of the brain or spinal cord, treatment with heparin or fibrolysin (i.v.) must be started immediately up to 20,000 units of heparin with normal blood pressure). Along with anticoagulants, antiplatelet agents and vasodilators (5 ml of a 2% solution of pentoxifylline, trental IV) should be administered, and hemodilution should be performed with rheopolyglucin (400 ml IV at a rate of 20-40 drops/min). During a crisis rise in blood pressure, it should be reduced to a “working” level due to a violation of the autoregulation of cerebral circulation during this period and the dependence of cerebral blood flow on the level of blood pressure. Improve microcirculation using dipyridamole (chimes, persantine - 2 ml of 05% solution IV or IM), trental (0.1 g - 5 ml of 2% solution IV dropwise in 250 ml of saline or 5% solution glucose), Cavinton (2-4 ml of 05% solution in 300 ml of physiological solution intravenously).

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

Disturbances in the rhythm and strength of heart contractions can be both the background against which a stroke develops (often embolic type) and a consequence of impaired central regulation of the heart. In the first case, emergency measures are carried out according to the same principles as for cardiac arrhythmias without cerebral circulation impairment. In this case, it is advisable to avoid large doses of beta blockers, especially anaprilin, and sudden arterial hypotension. For myocardial ischemia, the full scope of appropriate care is provided, which, as a rule, is also useful for cerebral ischemia. If possible, drugs that cause severe dilatation of 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 impairment of vital functions and in an agonizing state, when transportation itself is dangerous. Respiratory resuscitation is quite effective only for small-focal lesions of the brain stem.

Content

Damage to brain tissue that develops as a result of vascular damage and hemorrhage is called a hemorrhagic infarction or stroke. The pathology usually occurs suddenly, during the day or in the morning, with a sharp increase in blood pressure (hypertensive crisis), physical activity, severe stress or emotional shock. The consequences of a hemorrhagic stroke are often unfavorable.

What is hemorrhagic stroke

The clinical form of acute cerebrovascular accident (ACVA), resulting from spontaneous damage to cerebral vessels, is called hemorrhagic stroke. Such damage accounts for approximately 10–15% of all cases of stroke. The pathology is typical for middle-aged and young people. The following signs are characteristic of hemorrhagic lesions:

• Suddenness. More than half of all cases occur without any previous signs of damage.
• High mortality rate. Fatal outcome in 60–70% of patients; they die within the first 3–5 days after the lesion.
• Profound disability. According to statistics, 70–80% of people who have suffered a cerebral hemorrhage lose the ability to self-care.

Causes of cerebral hemorrhage

Hemorrhagic stroke of the brain usually develops due to a decrease in the elasticity and strength of cerebral vessels. In addition, the following factors can provoke hemorrhage:

• arterial hypertension;
• aneurysms;
• vasculitis;
• hemorrhagic diathesis;
• amyloid angiopathy;
• brain tumors;
• encephalitis;
• small idiopathic subarachnoid hemorrhages;
• hemophilia;
• obesity;
• smoking;
• addiction.

Kinds

In clinical practice, the location of the hemorrhage is of great importance, because It determines the scope of necessary treatment and rehabilitation. Depending on the location, the following types of stroke are distinguished:

Type of stroke	Localization
Subarachnoid	Subarachnoid space between the meninges
Parenchymatous	The periphery of the brain, hemorrhage occurs in the thickness of the organ.
Epidural	Epidural space between the meninges
Medial	Thalamus area
Lateral	Subcortical nuclei
Lobarny	Hemorrhage occurs within one lobe of the brain, involving gray and white matter.
Ventricular	Lateral ventricles
Combined	One hemorrhage affects several areas
Mixed (extensive hemorrhage)	Several hemorrhages appear in several places at once

The trigger for hemorrhagic brain damage is a pathological change in the permeability and integrity of cerebral vessels of different sizes. As a result, a hematoma is formed, the functioning of neurons is disrupted, and tissues begin to quickly die. In the pathogenesis of hemorrhagic stroke there are several stages:

1. The most acute. It occurs immediately after hemorrhage and lasts 24 hours. Characterized by the rapid development of coma, respiratory and heart failure. When providing medical care during this period, the risk of death and the development of severe complications is significantly reduced.
2. Spicy. It begins a day after the stroke and lasts about three weeks. During this period, symptoms increase slowly, and compensatory mechanisms are gradually activated.
3. I'll sharpen it up. It occurs 22-23 days after the lesion and lasts up to three months. Symptoms gradually fade away, tissue regeneration and restoration of cognitive and physical functions gradually begin.
4. Early recovery. Active processes of brain tissue restoration continue. Collateral circulation develops powerfully. The stage lasts from the third month from the onset of the disease to six months.
5. Late recovery. Glial scars or cystic tissue defects form at the site of the lesion. It begins in the seventh month after the defeat and lasts up to a year.
6. Stage of long-term consequences. It begins a year after the stroke, continues until all symptoms disappear completely, and sometimes persists for life.

Symptoms

Clinical symptoms of the disease, their severity and duration depend on the location of the lesion and its volume. The main signs of cerebral hemorrhage are:

• severe headaches;
• vomit;
• impaired coordination of movements (walking, standing, sitting);
• facial redness;
• disturbance of consciousness (stupor, stupor, coma);
• paresis and paralysis - impaired movement of the limbs on one half of the body, since they are constantly in a half-bent position and it is impossible to straighten them;
• speech disorder;
• convulsive syndrome;
• decreased muscle tone;
• mental disorders and irritability;
• visual impairment up to complete blindness;
• facial distortion;
• weakened breathing;
• hemiplegia, hemiparesis, hemihypesthesia;
• numbness of the skin of the limbs, face;
• vegetative state (lack of response to external stimuli and signs of brain activity in the presence of pulse and breathing).

Consequences of cerebral hemorrhage

After suffering hemorrhagic brain damage, the majority of patients experience a significantly reduced quality of life. People lose the ability to self-service, work, and move. In addition, the following consequences of a stroke are distinguished:

• memory and attention deteriorate;
• visual acuity decreases, sometimes to complete blindness;
• lack of sensitivity in the limbs and face;
• hearing loss;
• speech and writing disorders;
• mental disorders.

Diagnostics

To determine the presence of a stroke and its exact localization, modern instrumental diagnostic methods are used. These include:

1. Lumbar puncture. During the study, the spinal canal is punctured and cerebrospinal fluid is taken for examination. A stroke is indicated by the pink color of the cerebrospinal fluid and the presence of a large number of red blood cells in it.
2. Computer (CT), magnetic resonance imaging (MRI). Thanks to such studies, it is possible to quickly and accurately determine the presence of pathology in the brain, its location and size.
3. Angiography of cerebral vessels. In this study, a contrast agent is injected into the cerebral arteries and X-rays are taken. Angiography clearly shows the location of the hemorrhage and its cause.

First aid

The main goal of first aid for a stroke is to maintain breathing, heartbeat and urgent hospitalization. When providing first aid for a stroke, you must do the following:

• If there is no pulse in the peripheral arteries, heartbeat and breathing, chest compressions and artificial respiration should be performed.
• If there are convulsions, it is necessary to lay the victim on his side and place something soft under his head.
• Measure and adjust blood pressure.
• Apply an ice pack to your head: this will help constrict blood vessels and stop bleeding.

Treatment of hemorrhagic stroke

Stroke therapy should be carried out only in specialized clinics. For the first 5–7 days after the lesion, patients are placed in the intensive care unit, where the patient’s condition is monitored around the clock by qualified medical staff. If the course is favorable, the victim is transferred to the neurological department. Treatment of stroke involves drug therapy and, if necessary, surgery.

Non-surgical treatment

Complex conservative therapy is carried out for minor hemorrhages, and also as an addition to surgery. Non-surgical treatment includes:

• Adjustment of blood pressure. To eliminate hypertension, solutions of Enap, Benzohexonium, and Dibazol are administered intramuscularly or intravenously. If the patient’s consciousness during a hemorrhagic stroke is preserved, then Clonidine, Metoprolol, Farmadipine are used. For low blood pressure, Dopamine, Mezaton, and Prednisolone are used.
• In case of respiratory failure, the patient is intubated and connected to a ventilator.
• Elimination of cerebral edema using the following medications: Furosemide, Manitol, Dexamethasone or L-lysine.
• Improving the supply of oxygen and nutrients to brain cells using pharmacological agents such as Ceraxon, Thiocetam, Cortexin, Actovegin, Cavinton, Reosorbilact, Cytoflavin.
• To stop bleeding, Dicinone, Etamzilate, Vikasol, Aminocaproic acid are prescribed.

Surgical intervention

Surgical treatment is carried out within the first three to four days after hemorrhage. Indications for surgery for hemorrhagic stroke are:

• parenchymal hemorrhage in the brain with the formation of large hematomas;
• rupture of a large vessel;
• extensive hemorrhage in the brain due to a ruptured aneurysm.

Surgical removal of blood is aimed at reducing intracranial pressure, tissue decompression and preventing brainstem herniation. For hemorrhagic stroke, the following types of operations are used:

1. Trephination. During this surgical procedure, the doctor removes a fragment of the skull bone above the affected area. The accumulated blood is removed through the surgical wound. The advantage of trephination is that it allows you to quickly reduce intracranial pressure and cerebral edema. The operation is usually performed for superficial hematomas.
2. Puncture. During the operation, a puncture of the skull is performed under the control of computed tomography. The needle is carefully brought to the area of ​​hemorrhage and the blood is sucked out. Puncture is indicated for hemorrhagic lesions of the deep parts of the brain.
3. Draining. To eliminate the hematoma, special tubular drainages are installed to drain the cerebrospinal fluid from the ventricles. Manipulation helps reduce intracranial pressure.

Recovery after hemorrhagic stroke

Rehabilitation after a hemorrhagic lesion is a long and labor-intensive process. All measures are aimed at restoring the patient’s lost cognitive or physical functions. Rehabilitation includes:

• training on special simulators;
• prevention of bedsores;
• enriched nutrition;
• therapeutic massage;
• physical education and gymnastics.

Speech and memory restoration is carried out with the help of speech therapists and psychologists. The duration of rehabilitation after a stroke depends on the location, volume of the lesion, treatment provided, the presence of concomitant pathologies, and the age of the patient. Recovery time ranges from several weeks to several years. According to statistics, only 15–20% of patients return to a full life.

Recovery prognosis

With hemorrhagic lesions, the prognosis is unfavorable. The overall mortality rate is about 70%, of which 90% die within the first few days. The main causes of death are acute cerebral edema and repeated hemorrhage. Most surviving patients remain disabled for life. If the victim was hospitalized in the first 3-4 hours after a stroke, then the chances of survival and full recovery are maximum.

Prevention

Typically, cerebral hemorrhages are associated with high blood pressure (hypertension). Timely treatment of hypertension significantly reduces the risk of stroke. Prevention of hemorrhagic brain damage includes:

• giving up bad habits (smoking, drinking alcohol);
• adherence to sleep and rest patterns;
• elimination of stress, nervous tension;
• moderate physical activity;
• timely treatment of chronic pathologies;
• control of blood pressure, cholesterol and blood sugar.

Video

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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 prehospital test to assess 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 most likely sure of the diagnosis, call the ambulance that the patient has a stroke and requires the arrival of a neurological team. To the question "How do you know about the diagnosis?", in a confident voice, inform that the diagnosis was made by a 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 do not 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 hospitalize” 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 amounts to 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 assistance.

4. Patients with ischemic stroke are hospitalized in a neurological hospital (90% of stroke cases). Patients with hemorrhagic stroke are hospitalized in a neurosurgical hospital (10% of stroke cases). The type of stroke can only be determined by an 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 the 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 onto 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 airway.

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?

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 back of the head - this can worsen the blood supply to the brain!

4. Reflexotherapy and micro-bloodletting 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 influence (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. With increased blood pressure points are additionally punctured PC86 II and III fingers of each hand. If it is difficult to remember all the acupuncture points during the procedure, then at least remember about pricking all your fingers and earlobes with a syringe needle.

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 performed a Computerized Imaging 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 where 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 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. 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 mm Hg. 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 the 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 seat of the car, 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 his 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.

A sudden disruption of the blood circulation in the brain, as a result of which vital areas of the nervous system do not receive blood and neurons die, causes a stroke. The disease manifests itself in a number of life-threatening symptoms. Every year, the disease is diagnosed in every 5 residents of Russia, with death occurring in a third of all cases.

The sooner first aid is provided during a stroke, the greater the chance that the person will survive. In this case, the patient must be transported to a medical facility within three hours from the onset of the attack.

Classification

First aid for a stroke at home is an important step to save a person’s life.

However, you should know that preventing the consequences of an attack and completely restoring the functions of depressed blood circulation can only be done in medical institutions. Therefore, if you suspect a stroke, you first need to call an ambulance, and then begin providing emergency care.

To help the patient, it is important to know the types of diseases and their symptoms.

Circulatory disorders during a stroke can be of 2 types:

1. The ischemic type is called a brain infarction state. It develops due to the fact that the arteries that supply the brain with necessary substances are blocked by a blood clot. In this case, a blood clot can develop in the heart, leg arteries or any other vessels. As a rule, the main causes of ischemic disease are vascular atherosclerosis and. Most often diagnosed in people over 60 years of age.
2. A hemorrhagic type of circulatory disorder appears due to a rupture of a cerebral artery. Hemorrhagic stroke is a consequence of hypertension, when weakened cerebral vessels cannot withstand and rupture. For this reason, hypertensive patients need to strictly adhere to the treatment prescribed by their doctor. And in case of increased blood pressure or arrhythmia at home, strictly adhere to the algorithm to eliminate alarming symptoms. ). This type of stroke mainly affects people between 40 and 60 years of age.

Symptoms

It is difficult to diagnose one or another type of cerebral circulatory disorder at the time of providing emergency care for a stroke, but for doctors, distinguishing between types is very important, since the type of therapy depends on them.

In order to understand that a person is having a stroke, you can use a special technique that will help identify important symptoms of the disease.

• U – smile. The patient’s facial expressions change: he will be able to smile with only one half of his face;
• D – movement. After the patient raises both limbs, it will be clear that one of them is significantly lower than the other;
• A – articulation. A person affected by a stroke cannot speak clearly;
• R – solution. If at least one of the symptoms appears, emergency assistance for a stroke should be provided and doctors should be called.

Note!

“Male” stroke has several differences in its manifestations from “female” stroke.

The exact sequence and time of manifestation of symptoms cannot be predicted, since each body reacts to an attack differently. In addition, the signs can vary from different types of cerebral circulatory disorders.

With an ischemic stroke, the symptoms are more pronounced, and the attack itself is severe: a person can. In addition, with ischemia, the first signs begin to appear several days before the attack itself, while the hemorrhagic type occurs suddenly.

First aid

If you do not have experience in determining the type of attack, first aid for a stroke is carried out by following these recommendations.

If the person has not lost consciousness, the algorithm for action before the ambulance arrives is as follows:

• Calm the victim;
• Lay him comfortably, giving a higher position to the head and shoulder area;
• Provide a free flow of fresh air into the room;
• Remove or unfasten pressing items of clothing;
• Promote complete rest for the patient.

Note!

First aid for a stroke does not allow the use of medications until the patient is examined by doctors!

What not to do when a stroke occurs:

• Move the victim yourself or ask him to move;
• Use ammonia;
• Giving a person food or drink;
• Use drugs containing acids to bring the patient to consciousness.

Note!

The patient’s life depends on how quickly a medical team is called and first aid is provided.

Important Details

If you can distinguish the symptoms of an ischemic type of stroke from a hemorrhagic one, then help is differentiated:

Note!

If a person has hypertension, it is necessary to measure his blood pressure before being examined by doctors. Report the results of the study to doctors. Before they arrive, immerse the victim’s feet in a bath of hot water.

What to do if the patient is unconscious?

Turn his head to the side to prevent his tongue from sticking or vomit from entering the pharynx, warm his legs and arms, and provide a flow of fresh air.

If a patient has a stroke, accompanied by an extremely serious condition that has symptoms of clinical death (no breathing or heartbeat, the pupils of the eyes are dilated), emergency assistance must be provided:

• Tilt the patient's head back to the side;
• If necessary, free the oral cavity from mucus or masses and foreign objects;
• Wrap your fingers around the edges of the lower jaw and push it forward;
• Execute ;
• Massage the heart muscle.

Statistics show that first aid, competently provided, and the patient within the first three hours in a medical facility helps save lives in 60% of cases. 90% of patients fully recover their health and lead a full life. In 70% of patients, irreversible processes in the blood circulation of the brain will not occur.

Medical assistance

First aid for a stroke is provided by a team of doctors who arrive on call.

After a diagnostic examination, doctors carry out a number of measures aimed at restoring or maintaining impaired respiratory or cardiac function.

Honey. help consists of the use of medications, which are used depending on the symptoms and type of stroke. What to do if a patient has a stroke after hospitalization is decided by the doctors of the medical institution.

Prevention and recovery

Many people are not prepared for the manifestation of a stroke: people ignore doctors’ prescriptions, they do not systematically treat chronic diseases of the heart and blood vessels.

In addition, regular stressful situations, bad habits and poor nutrition increase the risk of the disease several times.

Therefore, in order to prevent the occurrence of this extremely dangerous condition for life and health, you must adhere to the following rules:

• Eat right;
• Give up bad habits;
• Follow all recommendations of your doctor;
• Monitor your blood pressure;
• Watch your weight;
• Properly alternate periods of physical activity and rest;
• Avoid stressful situations and long-term depression;
• Spend more time outdoors.