ACLS Provider: Course

Stroke Recognition and Management

Stroke is a medical emergency that occurs when blood supply to a part of the brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. This can lead to rapid cell death and permanent brain damage if not treated promptly. The ACLS guidelines emphasize rapid recognition, immediate activation of emergency services, and timely intervention to minimize brain damage and improve patient outcomes.

Recognizing Stroke Symptoms:

Use the FAST acronym to quickly and easily identify the most common stroke symptoms:

  • F: Facial Drooping: Ask the person to smile. Does one side of the face droop, or is there asymmetry? Is one side of the face numb or feeling heavy?
  • A: Arm Weakness: Ask the person to raise both arms. Is one arm weak or numb? Does one arm drift downward?
  • S: Speech Difficulty: Ask the person to repeat a simple sentence (e.g., "The sky is blue"). Is their speech slurred, difficult to understand, or are they unable to speak at all? Do they have trouble understanding what you are saying?
  • T: Time to Call Emergency Services (911 or your local emergency number): If any of these signs are present, even if they go away, time is critical. Act quickly and call emergency medical services immediately. Note the time of symptom onset, as this is crucial for determining treatment options.

Initial Assessment and Management:

  • Activate Emergency Response: Call emergency medical services (911 or your local emergency number) immediately. Provide the dispatcher with the location of the emergency and a description of the patient's symptoms. Time is brain, and prompt activation of EMS is essential for timely intervention.
  • Perform ABCs: Assess and manage the patient's airway, breathing, and circulation:
    • Airway: Ensure a patent airway. Be prepared to provide basic or advanced airway management if needed.
    • Breathing: Assess the patient's breathing and provide supplemental oxygen if necessary. Monitor oxygen saturation.
    • Circulation: Assess the patient's pulse and blood pressure. Manage any circulatory instability.
  • Obtain Patient History: Gather a brief but focused patient history, paying particular attention to the time of symptom onset (when the symptoms first started). This information is critical for determining eligibility for fibrinolytic therapy (clot-busting medication). Also, inquire about any medications the patient is taking, past medical history, and any potential contraindications to fibrinolytic therapy (e.g., recent surgery, bleeding disorders).
  • Transport to a Stroke Center: Rapid transport to a designated stroke center is crucial. Stroke centers have specialized resources and expertise, including access to rapid CT or MRI imaging, neurology specialists, and interventional procedures (e.g., thrombectomy) that can significantly improve patient outcomes.

Fibrinolytic Therapy (tPA):

  • Consider Administering Tissue Plasminogen Activator (tPA): tPA is a medication that can dissolve blood clots and restore blood flow to the brain in patients with ischemic stroke (caused by a blood clot). However, it must be administered within a specific time window from symptom onset (typically within 3–4.5 hours, but this window may be shorter in certain cases). Therefore, accurate determination of symptom onset is crucial.
  • Contraindications: There are several contraindications to tPA administration, including recent surgery, active bleeding, history of intracranial hemorrhage, and uncontrolled hypertension. A careful assessment of the patient's medical history and current condition is essential before administering tPA.
  • Monitor Closely for Signs of Bleeding or Worsening Symptoms: After tPA administration, close monitoring is essential to detect any signs of bleeding (e.g., internal bleeding, bleeding at puncture sites) or worsening neurological symptoms.