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Do You Know Exactly What to Do If You Have a Stroke?

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Of course, no one wants to have a stroke. But about 800,000 times a year someone in the US has one. Most often, it’s an acute ischemic stroke—blood flow to the brain is interrupted, starting a cascade of damage that can lead to death or disability.

The good news: Today’s stroke is not your grandfather’s stroke. Your chances of surviving and thriving have increased dramatically, thanks to recent advances. To have the best chance of recovering from a stroke, you need to act quickly—and smartly. Here are four mistakes that can make the difference between life and death…

MISTAKE #1: Not recognizing stroke symptoms. A stroke often causes multiple symptoms, but some people have only one. However, to spot one or more stroke symptoms, you need to recognize them.

Most people can name at least one of the many stroke symptoms. Classic symptoms include a droopy face on one side…numbness or weakness of the face, arm or leg (especially on just one side)…and trouble walking or balancing. But there are other symptoms that are also important to watch for…

• Trouble seeing in one or both eyes.
• Sudden confusion.
• A severe headache with no known cause.
• Sudden, unexplained dizziness.

Helpful: If you think someone near you may be having a stroke, think FAST. The letters stand for…

F: Face. Ask the person to smile to see if one side of the face droops.
A: Arms. Ask the person to raise both arms to see if one drifts downward or can’t be moved at all.
S: Speech. Ask the person to repeat a simple phrase and listen for slurring or other difficulties.
T: Time. If you see any of these signs, call 911 right away—and make note of the time. Medical personnel will want to know when the symptoms started.

MISTAKE #2: Ignoring a stroke symptom that lasts only a few minutes. You may have had (or witnessed) a transient ischemic attack, a so-called TIA or “ministroke.” That can be a warning that a bigger stroke is coming. You should still call 911. Important: If you witnessed a person who had possible stroke symptoms, be sure that the hospital team has your cell phone number so you can be reached to confirm what you observed in the patient.

MISTAKE #3: Getting a ride to the hospital. In a medical emergency, you may be tempted to wait to see what happens or have someone drive you to a hospital or doctor’s office. With a possible stroke, this is a very bad idea. Instead, call 911 and tell the operator you are seeing or having possible stroke symptoms. Don’t worry about being wrong.

Emergency medical workers will assess you and look for other conditions (such as low blood sugar, low blood pressure or a seizure) that could mimic a stroke. They can start treating such conditions right away. If the emergency crew suspects a stroke, they will call ahead to the nearest appropriate hospital so the medical team can prepare.

MISTAKE #4: Going to any hospital. With a stroke, it does matter what hospital you go to—and that’s another reason to call 911.

Under an accreditation system maintained by The Joint Commission, hospitals can get certifications ranging  from “acute stroke ready” for those with basic supports in place…to “primary stroke centers” for those offering more advanced care…to “comprehensive stroke centers” for those offering the most advanced state-of-the-art care.

A new approach: According to new guidelines from the American Heart Association/American Stroke Association (AHA/ASA), if the patient is having severe stroke symptoms, emergency personnel can travel an additional distance (up to 15 minutes) to reach a comprehensive stroke center. In some regions, the distance may need to be longer. And in some states, medics are required to take patients to the hospital of their choice, while other states leave this decision to emergency personnel. Medics are trained to make the best hospital choice for the patient’s needs.

GETTING THE RIGHT TREATMENT

If you are taken to the hospital as a possible stroke patient, ideally you will arrive with a loved one who can describe the onset of your symptoms and share your medical history. Important: Keep a cell phone number for a family member in your wallet—this is critical so that someone who knows you well can give medical information if you are alone and cannot speak for yourself.

If the hospital team determines that you may be having symptoms of an acute stroke, you will receive brain imaging—most often in a CT machine, ideally within 20 minutes of arriving at the hospital.

If your scan rules out bleeding in or around your brain (a hemorrhagic stroke) and you meet other criteria—including onset of your stroke no more than three to four-and-a-half hours earlier—you will get immediate intravenous treatment with a clot-busting medication called a tissue plasminogen activator, or tPA, to break up the clot in your brain, limiting damage and potential disability.

BEYOND tPA

There’s now an alternative to tPA called mechanical thrombectomy. This procedure physically removes the blood clot. It is sometimes done after or instead of clot-busting drug treatment. In some cases, you will need to be transferred to another hospital, by ambulance or helicopter, to get it.

Under guidelines from 2015, the procedure had to start within six hours of your initial stroke symptoms. This was a problem for people far from well-equipped and well-staffed hospitals or who woke up with symptoms (a so-called “wake-up stroke”) or had stroke symptoms of uncertain duration.

Now: The treatment window has been expanded. Studies show that some patients with blockage in a major artery leading to the brain can benefit from thrombectomy 16 to 24 hours after the stroke began.

Again, doctors will try to determine whether you are in that time window by asking when your symptoms started (or when you were last seen symptom-free). Patients also are screened with advanced brain-imaging tests to find those who still have large areas of brain tissue healthy enough to benefit from restored blood flow.

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Source: Michael Frankel, MD, professor of neurology at Emory University School of Medicine, and chief of neurology and director of the Marcus Stroke and Neuroscience Center at Grady Memorial Hospital, both in Atlanta. His team played a major role in the DAWN trial, published in The New England Journal of Medicine in January 2018. This study provided critically important data showing the benefit of thrombectomy within 24 hours of stroke onset. Date: May 1, 2018
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